Rigorous multi-disciplinary approach results in fewer infections,
deaths associated with hospital-onset C. difficile
Rhode Island Hospital has reduced the incidence of hospital-associated
Clostridium difficile (C. difficile) infections by 70 percent and
reduced annual associated mortality in patients with hospital-associated
C. difficile by 64 percent through successive implementation of five
rigorous interventions , as reported in the July 2013 issue of The
Joint Commission Journal on Quality and Patient Safety.
Clostridium difficile is a toxin-producing bacterium that lives in the
colon. A major cause of morbidity and mortality in the U.S., it can
cause life-threatening infections that occur most frequently in patients
who have received antibiotic therapy. Unlike other bacteria causing
healthcare-related infections, C. difficile can be difficult to clear
from the environment due to its ability to survive for prolonged periods
of time as spores.
“Hospital-acquired infections are a major concern for hospitals across
the country and C. difficile is among the most dangerous,” says
principal investigator Leonard Mermel, D.O., medical director of the
department of epidemiology and infection control at Rhode Island
Hospital. “The risks to patients are enormous, as is the excess
associated hospital cost.”
Mermel et al. note that from 2000 to 2009, discharge diagnoses from U.S.
hospitals that included C. difficile increased from 139,000 to 336,600 –
a 242 percent increase. Similarly, the yearly national excess hospital
cost associated with hospital-onset C. difficile is estimated to be
upward of $1.3 billion.
To measure and reduce the incidence of hospital-acquired C. difficile,
Mermel and his colleagues implemented a multi-step process based on a
risk assessment: develop and implement a C. difficile infection control
plan; monitor additional data sets, including associated mortality and
morbidity as measured by C. difficile-related colectomies; improve
sensitivity of C. difficile toxin detection in stool specimens to reduce
false-negative results; and enhanced environmental cleaning of patient
rooms and equipment.
Researchers monitored the number of C. difficile infections per 1,000
hospital discharges from the second quarter of 2006 to the third quarter
of 2012, and found that hospital-associated C. difficile infections were
reduced from a peak of 12.2 per 1,000 to 3.6 per 1,000 discharges.
Additionally, the mortality in patients associated with this infection
was reduced from a peak of 52 in 2006 to 19 in 2011, and by the end of
the third quarter of 2012, that number was down to 13.
“This is a significant, hospital-wide effort involving the support of
hospital administration, the department of epidemiology and infection
control, nursing, medicine, surgery, pathology, pharmacy, environmental
services and the microbiology lab. It is truly a multi-disciplinary
effort to make the hospital safer for our patients, their families and
our staff.” Mermel said.
“By working together to better monitor those patients at risk, enhance
the cleaning of patient rooms and equipment, and to use contact
precautions as appropriate, we were able to significantly reduce the
risk of this virulent infection and ultimately to provide better, safer
patient care.” According to the Centers for Disease Control and
Prevention, 94 percent of C. difficile infections are related to
receiving medical care, and hospital stays from this infection tripled
in the last decade, posing a patient safety threat especially harmful to
older Americans. The infection causes diarrhea linked to 14,000 American
deaths each year.
There was no outside funding for this study. Mermel’s principal
affiliation is Rhode Island Hospital, a member hospital of the Lifespan
health system in Rhode Island. He also has an academic appointment at
The Warren Alpert Medical School of Brown University, department of
epidemiology and infection control. Other researchers involved in the
study are Julie Jefferson, RN, MPH; Kerry Blanchard; Stephen Parenteau,
Benjamin Mathis, M.D.; Kimberle Chapin, M.D.; and Jason Machan, Ph.D.,
all are affiliated with Rhode Island Hospital and/or Brown University.