Study: C. Diff Sickens More Than Previously Estimated

November, 2008

The life-threatening bacterium that causes diarrhea and more serious intestinal conditions, Clostridium difficile, is sickening many more patients than previously estimated, according to a new study released by the Association for Professionals in Infection Control and Epidemiology (APIC).

“The National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities” indicates that 13 out of every 1,000 inpatients were either infected or colonized with C. difficile. Based on this rate, it is estimated that there are at least 7,178 inpatients on any one given day in American healthcare institutions with an associated cost of $17.6 to $51.5 million. The rate is 6.5 to 20 times greater than previous incidence estimates, according to the survey, released at APIC’s conference, “Clostridium difficile: A Call to Action,” in Orlando, Florida.

The APIC survey, the largest, most comprehensive of its kind, presents a one-day snapshot in time of the prevalence of C. difficile infection (CDI) in American hospitals. APIC’s 12,000 members collected data about all of their CDI patients on one day between May and August 2008. Survey results were collected from 12.5% of all medical facilities in the U.S. that care for virtually every type of patient, including those at acute care, cancer, cardiac, children’s, long-term care and rehabilitation hospitals. A total of 1,443 patients were identified with CDI from among the 648 participating hospitals.

CDI is most frequently associated with previous antibiotic use and is most commonly contracted by the elderly and those with recent exposure to hospitals, nursing homes and other healthcare institutions. It is transmitted by hand contact with items contaminated by feces. In the last five years, a more virulent and antibiotic-resistant strain has developed which has been associated with more serious disease, treatment failures and deaths.

“This study shows that C. difficile infection is an escalating issue in our nation’s healthcare facilities,” said William Jarvis, MD, principal investigator of the study and president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology. “ Clearly, preventing the development and transmission of CDI should be a top priority for every healthcare institution.”

According to the survey, 54.4 percent of patients with CDI were identified within 48 hours of admission and 84.7 percent were on the medical services, meaning they were being treated for general medical conditions like diabetes, pulmonary or cardiac problems and were on wards throughout the hospital.

“Our results show that the majority of CDI patients are admitted to the hospital already infected,” said APIC 2008 President Janet E. Frain, RN, CIC, CPHQ, CPHRM, Director, Integrated Services, Sutter Medical Center in Sacramento, CA. “Hospitals need to be looking for patients with severe diarrhea, and if CDI is suspected, promptly institute appropriate precautions such as gloves, gowns and separating patients, to avoid spreading the infection. Early recognition of CDI is critical so that prevention measures can be implemented.”

To reduce the risk of transmission, APIC has published a “Guide to the Elimination of Clostridium difficile in Healthcare Settings.” APIC recommendations include a risk assessment to identify high-risk areas for CDI within the institution; surveillance program to outline activities and procedures to provide early identification of CDI cases; adherence to CDC hand hygiene guidelines; use of contact precautions (e.g., gloves, gowns and separating CDI patients from other patients); environmental and equipment cleaning and decontamination, especially items that are close to patients such as bedrails and bedside equipment; and antimicrobial stewardship programs with focus on restriction of antibiotics associated with CDI and unnecessary antimicrobial use. APIC’s evidence-based elimination guides translate CDC recommendations into practice.

“Healthcare providers must intensify efforts toward developing prevention strategies that can be consistently applied across the continuum of care,” said APIC CEO Kathy L. Warye. “Control of CDI requires adequate numbers of infection preventionists and environmental services personnel, and prevention practices need to be part of everyone’s job within the institution. As part of our Targeting Zero initiative, APIC will continue to call for the commitment of clinical and administrative leadership to providing adequate resources for infection prevention programs to better protect patients in our nation’s healthcare facilities.”

The APIC National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities will be published in the American Journal of Infection Control. For more information about the study, visit www.apic.org.