Refining Our Approach to Clostridium difficile Prevention

Laura A. Stokowski, RN, MS; L. Clifford McDonald, MD

Disclosures

March 21, 2012

In This Article

No Getting Away From Clostridium difficile

Clostridium difficile (C difficile) is in the news again. This time, some of the news is good. In 3 state-led prevention programs, 71 hospitals that focused on prevention of C difficile infection (CDI) were able to cut their aggregate hospital-onset CDI rate by 20% in less than 2 years.[1]

The bad news is that for most of the country, CDI rates are still at an all-time high and remain strongly associated with exposure to healthcare. According to Emerging Infections Program surveillance, in 2010, 94% of CDIs occurred in patients who had received healthcare as an inpatient, outpatient, or both in the preceding 12 weeks.[1] C difficile infection is a rising cause of death in the most vulnerable patients. From 2000-2007, deaths from CDI increased 400% -- to 14,000 annually, at a cost of more than $1 billion.

It's time to reassess the way we think about C difficile.

C difficile infection is not just a frustratingly difficult-to-treat disease. It cannot be dismissed as a "hospital problem" or a "long-term care problem." It is a healthcare-wide patient safety problem. Like other patient safety problems, resolving CDI requires a multifaceted approach and a commitment to action from both multiple stakeholders and the individuals at the "sharp end" of patient care.

With the conviction that transmission of C difficile is avoidable but that no single action will be sufficient, the Centers for Disease Control and Prevention (CDC) outlined the 6 strategies that have the best chance of eradicating C difficile from healthcare. These strategies involve elements of antibiotic stewardship, testing for C difficile, isolation and infection control procedures, environmental cleaning, and communication[2]:

  1. Prescribe and use antibiotics carefully. About 50% of antibiotics that are given are not needed.

  2. Test for C difficile when patients have diarrhea while taking antibiotics or within several months of taking them.

  3. Isolate patients with C difficile immediately.

  4. Wear gloves and gown when treating patients with C difficile, even during short visits. Hand sanitizer does not kill C difficile, and handwashing may not be sufficient.

  5. Clean room surfaces with bleach or another Environmental Protection Agency (EPA)-approved spore-killing disinfectant after a patient with C difficile has been treated there.

  6. When a patient transfers to another facility, notify the new facility if the patient has CDI.

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