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Hospital Reduces <i>C. difficile</i> Infections by 70 Percent

Authors implement multi-step prevention program (June 20)

Rhode Island Hospital has reduced the incidence of hospital-associated Clostridium difficile infections by 70% and has reduced annual associated mortality in patients with hospital-associated C. difficile by 64% through successive implementation of rigorous interventions, according to a new report in the Joint Commission Journal on Quality and Patient Safety.

C. difficile is a toxin-producing bacterium that lives in the colon. A major cause of morbidity and mortality in the U.S., the bug can cause life-threatening infections, which occur most often in patients who have received antibiotic therapy. Unlike other bacteria that cause health care-related infections, C. difficile can be difficult to clear from the environment because of its ability to survive for prolonged periods as spores.

“Hospital-acquired infections are a major concern for hospitals across the country, and C. difficile is among the most dangerous,” said principal investigator Leonard Mermel, DO. “The risks to patients are enormous, as is the excess associated hospital cost.”

Mermel and his colleagues noted that discharge diagnoses from U.S. hospitals that included C. difficile increased from 139,000 to 336,600 between 2000 and 2009 — a 242% increase. Similarly, the yearly national excess hospital cost associated with hospital-onset C. difficile was estimated to be more than $1.3 billion.

To measure and reduce the incidence of hospital-acquired C. difficile, the authors implemented a multi-step process: 1) develop and implement a C. difficile infection control plan; 2) monitor additional data sets, including associated mortality and morbidity, as measured by C. difficile-related colectomies; 3) improve the sensitivity of C. difficile toxin detection in stool specimens to reduce false–negative results; and 4) ensure enhanced environmental cleaning of patient rooms and equipment.

The researchers monitored the number of C. difficile infections per 1,000 hospital discharges from the second quarter of 2006 to the third quarter of 2012, and found that hospital-associated C. difficile infections were reduced from a peak of 12.2 per 1,000 to 3.6 per 1,000 discharges. In addition, mortality associated with this infection was reduced from a peak of 52 in 2006 to 19 in 2011, and by the end of the third quarter of 2012, that number was down to 13.

“This is a significant, hospital-wide effort involving the support of hospital administration, the department of epidemiology and infection control, nursing, medicine, surgery, pathology, pharmacy, environmental services, and the microbiology lab. It is truly a multidisciplinary effort to make the hospital safer for our patients, their families, and our staff,” Mermel said.

According to the Centers for Disease Control and Prevention (CDC), 94% of C. difficile infections are related to medical care, and hospital stays from this infection tripled in the last decade, posing a patient safety threat that is especially harmful to older Americans.

Source: Rhode Island Hospital; June 20, 2013.

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