C difficile Prevention Efforts Increase, but Results Lag

March 12, 2013

Although healthcare centers have increased their intervention efforts to prevent Clostridium difficile infection (CDI) rates during the past 3 years, they have not experienced equal declines in associated CDI rates, according to a national survey of infection preventionists released March 11 at the Clostridium difficile Educational and Consensus Conference presented by the Association for Infection Control and Epidemiology (APIC).

Although 70% of survey respondents said they have implemented additional interventions since March 2010, only 42% have seen a decline in facility-associated CDI rates; 43% have not seen any decline. In addition, 75% had been performing CDI surveillance before the reporting requirements of the Centers for Medicare & Medicaid Services went into effect in January 2013.

Hiring is not increasing as it should, either: Only 21% of the respondents said they have added prevention staff since March 2010.

"We are encouraged that many institutions have adopted stronger measures to prevent CDI, but as our survey indicates, more needs to be done to reduce the spread of this infection," Jennie Mayfield, BSN, MPH, CIC, APIC president-elect and clinical epidemiologist at Barnes-Jewish Hospital, St. Louis, Missouri, said in a news release. "We are concerned that staffing levels are not adequate to address the scope of the problem."

CDI appears to be on the rise in the United States and is associated with 14,000 deaths each year, according to the Centers for Disease Control and Prevention. CDI, in addition to being potentially life-threatening, also causes diarrhea and other serious intestinal problems.

APIC surveyed its US membership of 14,000 preventionists, including nurses, physicians, public health professionals, and medical technologists, of whom 1087 members responded completely. Those who have not been more aggressive against CDI in the last 3 years most often cited preexisting best-practices programs before 2010.

Practices Vary

Isolation practices vary widely among healthcare facilities, which for this survey included centers for acute care (78%), long-term care (9%), ambulatory care (4%), and other services (9%). Although 42% keep patients with CDI in isolation the entire duration of their stay, 25% keep patients in isolation until treatment has started and no diarrhea has occurred within 48 hours. No national isolation practice recommendation exists.

For patient practices, 77% of respondents said they promote soap-and-water handwashing but also offer alcohol-based hand rubs. "Current opinions regarding the use of handwashing with soap and water instead of [hand rubs] are conflicting," the APIC says in the survey results.

Almost all (92%) respondents said they have increased emphasis on environmental cleaning practices since March 2010, but 64% said they are monitoring efforts only by observation rather than with monitoring technologies, and 14% percent said room cleaning was not monitored. Although 67% said they use bleach for cleaning rooms, only 9% said they have used an emerging disinfectant such as ultraviolet light or vaporized hydrogen peroxide.

Among other findings, 60% had antimicrobial stewardship programs compared with 52% in 2010, 85% of preventionists have participated in educational sessions, and 50% have started patient-education programs.

Most (78%) respondents said they have used the APIC Implementation Guide on CDI to help make improvements.