Nursing homes, hospitals face increase in C. diff cases

Posted on behalf of Stewart Bell, PLLC on Jun 15, 2011 in Nursing Home Injury or Death

When you think about problems in nursing homes , you think about bed sores and falls -- things that are a sign of abuse or neglect and stories that will break your heart. But Clostridium difficile infection (CDI), a rapidly increasing problem in nursing homes, hospitals and other health care settings, has nothing to do with abuse or neglect. A patient can acquire CDI in the Ritz Carlton of care facilities if the organization doesn't adhere to aggressive prevention measures, according to an infectious disease expert.

The statistics are numbing. About half a million people suffer from CDI, and that number goes up almost 10 percent every year. The mortality rate is high: 16.7 percent of patients will die within the first year of contracting C. diff. These numbers are estimates, because CDI is not reported nationally, as, for example, syphilis is. Still, experts see signs of an impending epidemic.

What challenges health care professionals the most is how fast and how easily the infection spreads -- and not just from patient-to-patient or patient-to-visitor. The spores are so hardy they can survive for months on a surface. The infection can be transmitted from a contaminated hand or contaminated hospital equipment. And contamination is not limited to the person with the active infection. A person can carry the spores without being sick.

As if all this weren't bad enough, CDI is hard to treat. Antibiotics may kill the infection, but the antibiotics can kill off the so-called good bacteria that fight off the C. diff bacteria. As soon as the patient is done with the medication, re-infection is a serious risk.

The infection is easily transmitted by a person or even a contaminated surface, and the symptoms -- diarrhea, colitis, ruptured colon and sepsis -- can be exacerbated by the antibiotics used to treat it.

The most recent data for West Virginia shows CDI listed as a diagnosis on almost 2,000 hospital discharges in a year. C. diff is a life-threatening infection -- in this state, the death toll from CDI increased almost 70 percent between 2001 and 2005.

When experts talk about preventing CDI, they are also talking about containing the infection. Here, we will talk about how to prevent further transmission of the infection.

Staff must be educated to recognize the symptoms of CDI. Most often, patients will experience persistent, watery diarrhea, accompanied by fever, abdominal pain or tenderness and nausea, among other things.

Facility leadership should direct labs to process CDI tests as quickly as possible. Again, the infection spreads quickly, so confirming the symptoms as C. diff is critically important.

A patient who tests positive should be isolated immediately. Access to the patient should be limited, and those who do come in contact should be gowned, gloved and masked.

Every surface must be cleaned and sterilized. The bacteria can survive for months on a bathroom surface, for example, so the cleaning/sterilizing should not only include surfaces the patient has come into contact with, but also surfaces the patient's caregivers could have touched.

Experts say successful organizations will develop policies and procedures that cover each step in detail. In turn, each department and each staff member should be held accountable for following assigned steps. The approach must be aggressive and system-wide to be effective.

Organizations that are concerned about compliance need only remind staff that the frail and elderly patients are particularly susceptible. And, really, the toll CDI takes on a patient may be incentive enough.

Source: Infection Control Today, "Best practices for addressing CDI," 06/blog/2011

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