C. diff Intestinal Infection Rising Among U.S. Healthcare Inpatients

The rate of a life-threatening bacterium that causes diarrhea and more serious intestinal conditions has been increasing among U.S. healthcare facility inpatients, according to a survey published this month in the American Journal of Infection Control and originally released in November 2008. Clostridium difficile is sickening many more patients than previously estimated, according to the survey conducted by the Association for Professionals in Infection Control and Epidemiology (APIC). 

“The National Point Prevalence of Clostridium difficile in U.S. Healthcare Facility Inpatients, 2008” indicates that 13 out of every 1,000 inpatients were either infected or colonized with C. difficile.  The rate is 6.5 to 20 times greater than previous incidence estimates, according to the survey. Based on this rate, it is estimated that there are at least 7,178 inpatients on any one given day in American healthcare institutions with an associated cost of $17.6 to $51.5 million. Of those who responded, 82 percent reported that C. difficile infection rates had not decreased over the past three years. 

“This study shows that C. difficile infection is an escalating issue in our nation’s healthcare facilities,” said William Jarvis, MD, principal investigator of the study and president and co-founder of Jason and Jarvis Associates, a private consulting firm in healthcare epidemiology. “Clearly, preventing the development and transmission of CDI should be a top priority for every healthcare institution.”

The APIC survey, the largest, most comprehensive of its kind, presents a one-day snapshot in time of the prevalence of C. difficile infection (CDI) in American hospitals.  APIC’s more than 12,000 members collected data on their CDI patients on one day between May and August 2008. Survey results were collected from 12.5 percent of all medical facilities in the U.S. that care for virtually every type of patient, including those at acute care, cancer, cardiac, children’s, long-term care and rehabilitation hospitals. A total of 1,443 patients were identified with CDI from among the 648 participating hospitals.

CDI is most frequently associated with previous antibiotic use and is most commonly contracted by the elderly and those with recent exposure to hospitals, nursing homes and other healthcare institutions.  It is transmitted by hand contact with items contaminated by feces. In the last five years, a more virulent and antibiotic-resistant strain has developed which has been associated with more serious disease, treatment failures and deaths.

To reduce the risk of transmission, APIC has published a “Guide to the Elimination of Clostridium difficile in Healthcare Settings.” APIC recommendations include a risk assessment to identify high-risk areas for CDI within the institution; surveillance program to outline activities and procedures to provide early identification of CDI cases; adherence to CDC hand hygiene guidelines; use of contact precautions (e.g., gloves, gowns and separating CDI patients from other patients); environmental and equipment cleaning and decontamination, especially items that are close to patients such as bedrails and bedside equipment; and antimicrobial stewardship programs with focus on restriction of antibiotics associated with CDI and unnecessary antimicrobial use. APIC’s evidence-based elimination guides translate CDC recommendations into practice.

Reference: AJIC. 2009; 37 [4]: 263-270.