Many of the Best US Hospitals Losing Ground to C difficile, With Rates Worse Than National Average

Troy Brown, RN

March 03, 2016

Some of the best and brightest hospitals in the United States are losing ground in the battle against Clostridium difficile (C diff) infection, according to new figures from Consumer Reports.

Overall, the bacterium infects approximately 450,000 people and plays a role in the death of about 29,000 people each year. In 2014, 101,074 patients were infected in hospitals, according to the Centers for Disease Control and Prevention (CDC).

Hospitals have made progress in preventing some hospital-acquired infections including those in central-line catheters, but C diff rates rose by 4% during 2013 and 2014, the CDC says.

Consumer Reports rated more than 3200 US hospitals and found that about a third of them, including 24 of the country's largest teaching hospitals, have C diff infection rates that are worse than those of the national average.

The poorly performing hospitals include notable teaching institutions such as Baylor University Medical Center in Dallas, Texas, the Cleveland Clinic in Ohio, Johns Hopkins Hospital in Baltimore, Maryland, Mount Sinai Hospital in New York City, and Massachusetts General Hospital in Boston.

"Teaching hospitals are supposed to be places where we identify the best practices and put them to work," Lisa McGiffert, director of Consumer Reports' Safe Patient Project, said in a news release. "But even they seem to be struggling against this infection."

Teaching Hospitals With Low Scores in Preventing C diff

Listed below are the 24 large teaching hospitals with low scores in preventing C diff. All are teaching hospitals with at least 500 beds and 200,000 patient days.

Aurora St. Luke's Medical Center, Milwaukee, Wisconsin
Baylor University Medical Center, Dallas, Texas
Beaumont Hospital – Royal Oak, Michigan
Brigham and Women's Hospital, Boston, Massachusetts
Cedars-Sinai Medical Center, Los Angeles, California
Christiana Care Health System, Newark, Delaware
Cleveland Clinic, Ohio
Hospital of the University of Pennsylvania, Philadelphia
Indiana University Health University System, Indianapolis
Inova Fairfax Hospital, Falls Church, Virginia
Johns Hopkins Hospital, Baltimore, Maryland
Massachusetts General Hospital, Boston
MedStar Washington Hospital Center, Washington, DC
Montefiore Medical Center, Bronx, New York
Mount Sinai Hospital, New York City
Thomas Jefferson University Hospitals, Philadelphia, Pennsylvania
University of Maryland Medical Center, Baltimore
University of Michigan Hospitals and Health Centers, Ann Arbor
UF Health Shands Hospital, Gainesville, Florida
UPMC Presbyterian Shadyside, Pittsburgh, Pennsylvania
VCU Medical Center, Richmond, Virginia
Vidant Medical Center, Greenville, North Carolina
Wake Forest Baptist Medical Center, Winston-Salem, North Carolina
Yale-New Haven Hospital, Connecticut


Teaching Hospitals With High Scores in Preventing C diff

About 28% of US hospitals were awarded one of the top two scores for preventing C diff, but only four were large teaching hospitals. All are teaching hospitals with at least 500 beds:

Harris Health System in Houston, Texas
Maine Medical Center in Portland
Maimonedes Medical Center in Brooklyn, New York
Mount Sinai St Luke's–Roosevelt in New York City


Why C diff Is Hard to Control

Two main reasons explain the spread of C diff. Antibiotics cure many infections and save countless lives, but they are often prescribed inappropriately — either to patients who don't need them, or to patients with infections better treated by different antibiotics. "Those drugs are obviously lifesaving when used appropriately, but they can also make you vulnerable to C. diff," Erik Dubberke, MD, associate professor of medicine in the division of infectious diseases at Washington University School of Medicine in St Louis and a spokesperson for the Infectious Diseases Society of America, said in the news release.

These antibiotics can kill the beneficial bacteria that are normally present in the stomach, allowing the spread of harmful bacteria, including C diff. Approximately half of all hospitalized patients are given antibiotics, and as many as half of those are given unnecessarily or inappropriately, according to the CDC. Stronger antibiotics such as ciprofloxacin complicate the situation even further because they are designed to work against several bacteria at once.

Poor hygiene is another key reason for the spread of C diff, according to the news release. The bacterium is present in fecal matter and spreads easily from person to person on the hands as well as on inanimate objects like bed rails, intravenous poles, and door knobs, where it can survive for weeks.

Good handwashing and wearing gloves can prevent the spread of the disease, but less than a third of healthcare workers in intensive care units wash their hands when and how they should, a 2014 University of Iowa study found.

Hospitals Respond

Teaching hospitals often care for sicker patients than nonteaching hospitals, according to Craig Civale, a spokesman for Baylor University Medical Center (BUMC). "As a major academic hospital in an urban setting, BUMC routinely admits very complex patients with multiple conditions," he said in the news release.

In addition, teaching hospitals may detect more cases of C diff because of more careful testing and reporting, Lisa Maragakis, MD, senior director of healthcare epidemiology and infection control for the Johns Hopkins Health System, explained in the news release.

Hospitals continue to address the problem of C diff by educating about hand hygiene and antimicrobial stewardship, but there is still much to be done. "The results reported by Consumer Reports are disappointing to us," a spokeswoman for Mount Sinai Hospital said in a statement to Consumer Reports.

"Mount Sinai also said that it has recently established a task force to look into the hospital's infection rates, and is investigating 'evidence-based practices targeted to reduce all healthcare-associated infections,' " according to the Consumer Reports news release.

"At Baylor, the hospital is developing new protocols to ensure that antibiotics are prescribed appropriately," Civale said in the news release. "Johns Hopkins is taking similar steps, and is also instituting 'rigorous hand hygiene and environmental cleaning initiatives,' " Dr Maragakis said in the release.

The Cleveland Clinic told Consumer Reports in a statement that the hospital is "committed to continuous improvement in quality and safety."

Additional information about hospital rankings for prevention of five different types of infections and other important safety measures is available here.


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