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Big-Name Hospitals Get Low Marks for Preventing C. difficile Infections

Institutions overlook simple precautions

A recent Consumer Reports analysis has given several of the nation’s largest teaching hospitals low ratings for Clostridium difficile infection control. The organizations include the Baylor University Medical Center in Dallas, the Cleveland Clinic in Cleveland, the Cedars–Sinai Medical Center in Los Angeles, and Mount Sinai Hospital in New York City.

In an announcement of the findings, Lisa McGiffert, Director of Consumer Reports’ Safe Patient Project, said: “Teaching hospitals are supposed to be places where we identify the best practices and put them to work, but even they seem to be struggling against this infection.”

According to the report, the weapons needed to defeat C. difficile are inexpensive and straightforward: soap, gloves, disinfectants, and the proper use of antibiotics. The Centers for Disease Control and Infection (CDC) has suggested methods for tackling C. diff that include detailed protocols for hand hygiene and room cleaning as well as suggestions about nurse-to-patient ratios and the importance of hospital leadership, but the agency lacks the authority to mandate such protocols.

Of the 3,100 hospitals that were evaluated, approximately one-third received low marks for C. difficile infection control, meaning that their infection rates were worse than the national benchmark. The ratings were based on data that the hospitals had reported to the CDC between October 2014 and September 2015.

Only two large teachings hospitals—those with at least 500 beds—earned one of the top two scores against C. difficile, meaning that their C. difficile infection rates were at least 50% better than the national benchmark. These organizations were Maimonedes Medical Center in Brooklyn, New York, and Mount Sinai Medical Center in Miami Beach, Florida.

Many of the surveyed hospitals acknowledged that C. difficile infections are a widespread problem and have stepped up efforts to combat the problem. Baylor University Medical Center, for example, told Consumer Reports that it has developed new protocols to ensure that antibiotics are prescribed appropriately. In addition, the hospital isolates any patient admitted with signs or symptoms of C. difficile infection, even if they haven’t yet tested positive. Baylor has also started using a daily disinfectant that has been approved by the Environmental Protection Agency (EPA) to fight C. difficile infections.

At Cedars–Sinai Medical Center, all patients with diarrhea are tested for C. difficile, a spokeswoman for the hospital said. The center’s antibiotic stewardship program has been expanded for both inpatients and outpatients, and the hospital said it has already seen a reduction in C. difficile cases between 2015 and 2016.

Combating C. difficile, which is found in fecal matter and is easily passed from person to person, requires intense vigilance, the Consumer Reports article points out. Rooms must be cleaned with stringent, EPA-approved cleaners that contain germ-killing agents (such as bleach) every time an infected patient passes through. In addition, to prevent the bug’s spread by health care workers, hands must be gloved as often as possible and, once the gloves are removed, washed thoroughly and regularly.

A 2014 University of Iowa study found, however, that less than one-third of health care workers in intensive care units always washed their hands. And in a Consumer Reports survey of 1,200 recently hospitalized individuals, only half reported “always” seeing their doctor or nurse wash their hands.

Source: Consumer Reports; September 27, 2016.

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