Hospitals step up to cut C. diff infections
Published 12:55 pm, Monday, July 8, 2013
Hospitals throughout the state have been waging a war in recent years, fighting against an enemy that can lurk within their walls. The enemy can be deadly. It can't be killed with some traditional weapons, such as alcohol-based hand sanitizer and most antibiotics, but responds well to others, such as soap, water and bleach.
The enemy is clostridium difficile, often referred to as "C. difficile" or "C. diff," a bacterium that causes intestinal problems, ranging from diarrhea to kidney failure to a hole in the large intestine.
The organism causes 337,000 infections and 14,000 deaths every year and infections have been on the rise for at least the past decade.
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The Centers for Disease Control and Prevention report that 94 percent of infections are linked to medical care, whether in a hospital, or another medical setting, such as a clinic or nursing home. The good news is that C. diff infections at many area hospitals have actually declined in recent years, due to increased safety precautions that range from relatively low-tech -- such as increased vigilance about hand-washing -- to the highly sophisticated, such as a robot at Stamford Hospital that uses ultraviolet light to kill bacteria.
Where C. diff comes from
Though C. diff infection isn't a new illness, the CDC reported that a new, stronger strain of the bacteria was found in the early 2000s. That strain is thought to more virulent and antibiotic-resistant than previous versions. The CDC reported that hospital stays related to C. diff infections tripled in the last decade and deaths related to the bacteria rose 400 percent between 2000 and 2007 -- an increase that was largely attributed to the new strain.
Medical experts say there is a link between the increased prevalence of C. diff infections and widespread use of antibiotics -- medications that kill bacteria. There has been concern in recent years that these medications are overprescribed. Not only does this make certain bacteria more resistant to the medications, but the drugs can make the body more vulnerable by killing off good bacteria for several months.
C. diff has actually been linked to causing the diarrhea that many people get when they take antibiotics. Not all cases of C. diff infection are serious, said Dr. Michael Parry, director of infectious diseases and microbiology at Stamford Hospital. When it causes relatively mild symptoms, such as diarrhea for a short period of time "it's pretty much of a nuisance," he said.
But, experts said, C. diff infections -- even mild ones -- can be fatal if not treated. The bacteria can lead to kidney failure, a hole in the large intestine and a condition called a toxic megacolon, in which the colon can't expel gas or stool and become grossly bloated. The diarrhea itself can lead to life-threatening dehydration if it's severe.
In about 20 percent of cases, C. diff can be treated by stopping whatever antibiotics the patient is on. The infection, ironically, is then often treated with one of three specific kinds of antibiotics -- metronidazole, vancomycin or fidaxomicin. In some severe cases, the patient may need surgery to remove part of the intestine. Another form of treatment that's still relatively rare is a fecal transplant, which uses donated stool to repopulate an infected gut with healthy bacteria.
However, many medical professionals said preventing the spread of C. diff is as important as treating the actual infections.
What's being done to fight it
C. diff infections aren't always acquired in medical care. The bacteria is also present in the environment and can be found in some food sources, including ground beef. The good news is that research shows hospitals can lower C. diff infections by 20 percent within two years by taking some basic precautions. Locally, several local hospitals said they've cut their rates by at least that. At Stamford Hospital, for example, infections have declined 28 percent over the past five years, said Dr. Rohit Bhalla, the hospital's chief quality control officer. At St. Vincent's Medical Center in Bridgeport, there was a 53 percent reduction in infections between this year and last, said Dr. Mitchell Fogel, chairman of the hospital's department of medicine and vice president of medical services.
Because hospitals all track rates differently and, as of yet, haven't submitted their numbers to the Connecticut Hospital Association, it's unknown whose rates are the highest and lowest, said Mary Reich Cooper, chief quality officer for the Connecticut Hospital Association. However, she suspects that C. diff infections have declined across the board in the past few years, due to increased attention to cleanliness and to not over-prescribing antibiotics.
"Antibiotic stewardship," or making sure antibiotic medications are only prescribed when necessary, is a huge part of preventing the spread of C. diff, experts said.
"In all the hospitals now, (staff) watch the kind of antibiotics people use and what they use them for," Cooper said. "When I grew up, people were put on antibiotics for ear infections the entire time (they were sick). Now, they don't do that. We need to be very precise in prescribing antibiotics, because of problems like C. diff."
In addition to curbing overuse of medications, other major prevention efforts include two that seem like no-brainers -- hand-washing and cleaning hospital rooms with bleach. Bhalla said hand-washing is particularly important when it comes to C. diff, because C. diff spores can't be killed with alcohol-based hand sanitizer. Many hospitals, including Stamford, employ hand-washing snoops -- they call them "mystery shoppers" -- to make sure workers are properly washing their hands.
"They don't just look at `Did you do it?' but `Did you do it in the appropriate way?' " Bhalla said. In other words, the hand-washing police monitor whether people wash their hands for long enough, with the appropriate amount of soap and water and before and after caring for every patient.
Stricoff said hand hygiene is also a major concern at Greenwich.
"Even if (workers) are just going in a room to say `Hi, how are you?' to a patient and don't touch anything, they have to wash their hands going in and going out, just to make sure they don't pick anything up or take anything out with them," she said.
Hospitals also have gotten more vigilant about scrubbing down rooms with bleach, which is one of the few cleaning products that eradicates C. diff spores.
Some facilities have taken high-tech safety measures, such as Stamford, which, last year, added a germ-zapping robot from the Texas-based company Xenex. The machine zaps a room with ultraviolet, killing any bacteria in its path.
"It's not just for C. diff," Bhalla said, adding the hospital was the only one in the state to have the machine. "It can kill everything else. It's just an extra level of cleanliness."
However, despite the progress made against C. diff, it's still going to be a while before the bacteria is completely eradicated from the hospital setting. Copper said hospitals will continue to do all they can to keep spread of the bacteria -- and other hospital-acquired infections -- at a minimum. Yet there isn't a single solution that would make banishing the infections easier. "Everybody is looking for a magic bullet to stop C. diff," she said. "But there isn't one yet."
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