New Study Shows High C. difficile Rates in Many US Hospitals

While some may think of infectious diseases as a problem largely plaguing the developing world, antibiotic-resistant “superbugs” have shattered the notion that our modern, sparkling hospitals are so aseptic. Consumer Reports recently evaluated more than 3,100 hospitals in the United States and found that about a third of them received a low rating for controlling infections from Clostridium difficile.

While antibiotic medications are still hailed as important pathogen-stopping life savers, rapidly evolving “superbugs” are more resistant than ever to medical treatment, and the more antibiotics we throw at them the stronger the pathogens become. What were once powerful tools in public health now threaten to undo years of progress controlling infectious diseases. A 2013 report on antibiotic resistance threats from the Centers for Disease Control and Prevention (CDC) listed the 18 worst drug-resistant pathogens in the United States, and topping that list was C. difficile, and with good reason. Infections from these bacteria are an urgent threat to health, according to CDC studies, which show that the problem is only getting worse. The 2013 report estimated 250,000 C. difficile infections a year in the United States, but an updated study from 2015 found that Americans experience nearly half a million of these infections each year. Of those, approximately 29,000 patients die within 30 days of their C. difficile infection diagnosis, with some 15,000 deaths directly attributable to the infection.

The new Consumer Reports study highlights the issue of healthcare-associated infections, and how hospital patients receiving antibiotic medications continue to remain at high risk of developing C. difficile infections. More than half of all hospitalized patients receive an antibiotic at some point during their hospital stay, but up to 50% of these drugs prescribed in hospitals are given unnecessarily or inappropriately. Decreasing the use of antibiotics by 30% in hospital patients can reduce dangerous healthcare-associated C. difficile infections by more than 25%; therefore, there has been increased scrutiny in prescribing practices, due to drug-resistant infection rates in US hospitals.

The recent study focused on large teaching hospitals from around the country. Researchers found that 19 of these facilities had a low rating for preventing C. difficile infections, meaning that the hospitals had an infection rate worse than the national benchmark. Only two large teaching hospitals in the study received high scores, with C. difficile rates at least 50% better than the national benchmark. The ratings were measured based on data reported by hospitals to the CDC from October 2014 through September 2015, in teaching hospitals with at least 500 beds and 200,000 patient days to report during that period. Fifteen of the hospitals receiving low scores in preventing C. difficile had also received low scores six months earlier, although many scored much better on infection rates of methicillin-resistant staphylococcus aureus and other healthcare-associated infections.

Clifford McDonald, MD, a senior advisor at the CDC’s Division of Healthcare Quality Promotion, says the agency works with state health departments, hospital associations, and hospital improvement innovation networks contracted by the Centers for Medicare and Medicaid Services to tackle high infection rates in healthcare settings. “One way CDC does this is through the targeted assessments for prevention strategy, which identifies and addresses infection prevention in hospitals with the highest infection rates. In addition, in 2016 the CDC provided $67 million to help health departments nationwide tackle antibiotic resistance and Clostridium difficile across healthcare settings and communities.”

The CDC says that antibiotic stewardship programs aimed at improving the use of these medications in hospitals can greatly reduce healthcare-associated infections and other adverse events. Doctors and care givers can greatly prevent the spread of C. difficile infections in hospitals with some of the following protocols:

• Use antibiotics judiciously.
• Use contact precautions for patients with known or suspected C. difficile infection. Place these patients in private rooms. If private rooms are not available, these patients can be placed in rooms with other patients with C. difficile infection.
• Use gloves when entering patients’ rooms and during patient care. Preventing contamination of the hands via glove-use remains the cornerstone for preventing C. difficile transmission via the hands of healthcare workers.
• Perform hand hygiene after removing gloves.
• Because alcohol does not kill C. difficile spores, use of soap and water is more efficacious than alcohol-based hand rubs. However, early experimental data suggest that even with use of soap and water, the removal of C. difficile spores is more challenging than the removal or inactivation of other common pathogens.
• Any theoretical benefit from instituting soap and water must be balanced against the potential for decreased compliance resulting from a more complex hand hygiene message.
• Implement an environmental cleaning and disinfection strategy. Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently.