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Hospitals Aren’t Doing All They Can to Prevent C. diff Infections, Study Finds

Many facilities lack programs to cut use of antibiotics that encourage dangerous gut infection

Nearly half of American hospitals aren’t taking key steps to prevent a kind of gut infection that kills nearly 30,000 people annually and sickens hundreds of thousands more –– despite strong evidence that such steps work, according to a new survey from the University of Michigan.

While nearly all of the 398 hospitals in the study used a variety of measures to protect their patients from Clostridium difficile infections, 48% hadn’t adopted strict limits on the use of antibiotics and other drugs that could allow the dangerous bug to flourish, the researchers report.

Hospital patients are especially prone to developing C. difficile infections and experiencing serious effects –– especially after they take antibiotics that disrupt the bacteria in their digestive systems.

The results from a national random sample of hospitals were published online in Infection Control & Hospital Epidemiology.

Virtually all of the hospitals had programs to monitor for C. difficile infections and used protective gear, separate hospital rooms, and special cleaning techniques when treating a C. difficile-infected patient so that the infection wouldn’t spread to other patients. In addition to being present in bodily fluids, C. difficile can form spores that persist in the hospital environment for weeks.

The lack of antimicrobial stewardship programs persisted in nearly half of the hospitals, despite the fact that almost all of the infection-control leaders surveyed agreed that such efforts have been proven to prevent C. difficile infections.

In addition to the lack of antimicrobial stewardship programs, the researchers also found a widespread lack of written policies to test patients for C. difficile infection when they developed diarrhea while taking antibiotics or within several months of taking them. Nearly three-quarters of hospitals didn’t have such policies, even though diarrhea is a key symptom of C. difficile infection –– and can lead to dangerous complications and death in vulnerable hospitalized patients.

C. diff infection over the last decade has emerged as a threat to patients, especially the most vulnerable and the elderly, and has increased in incidence and severity,” said lead author Sanjay Saint, MD, MPH.

“There are many ways to try to limit the spread, and from our data it looks like hospitals are aware of the evidence behind them and are acting on many where they believe the evidence is strong,” he continued. “But the one area where there’s a major disconnect between evidence and practice is antimicrobial stewardship, or limiting antibiotics to use only when necessary. This is a real opportunity for improvement.”

For the new study, Saint and his colleagues surveyed infection-control leaders at hospitals as part of an ongoing project that started in 2005. More than 70% of the 571 hospitals that received the survey responded to it.

More than 60% of hospitalized patients receive antibiotics, and as much as 50% percent of that antibiotic use may be inappropriate, according to other research.

Saint notes that reducing antibiotic use in hospitals not only reduces the risk of C. difficile infection, it also reduces the chance that bacteria will develop antibiotic resistance.

Last fall, the White House set a goal of reducing C. difficile infections by 50% by 2020 as part of its National Strategy for Combating Antibiotic-Resistant Bacteria. The Centers for Disease Control and Prevention has also targeted C. difficile as a key threat to public health. Further, hospitals’ C. difficile infection rates among Medicare participants are publicly reported on the Hospital Compare website operated by the U.S. Department of Health and Human Services.

Saint points to a Michigan-based effort that is working to help hospitalists improve quality and safety. The Michigan Hospital Medicine Safety Consortium is exploring collaborations between hospitalists and infectious disease prevention specialists to reduce the use of antibiotics.

“The doctors who prescribe most of these antibiotics, and who would have to buy in to stewardship programs, are hospitalists,” Saint said. “Nationally, they’re the ones we must engage with to overcome this disconnect between what people think works and what they’re actually doing, and to implement stewardship programs. This is about changing physician behavior, and that makes it more challenging.”

Source: University of Michigan Health System; April 24, 2015.


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