C. diff prevention activities fail to halt spread of deadly infection: survey

Staffing, monitoring of hospital cleaning have not kept pace with scope of problem

Activities to stop the spread of the intestinal superbug Clostridium difficile are on the rise, but they are not yielding large improvements, according to a nationwide survey of infection preventionists released today by the Association for Professionals in Infection Control and Epidemiology (APIC).

According to the new survey, 70 percent of infection preventionists have adopted additional interventions in their healthcare facilities to address C. difficile infection (CDI) since March of 2010, but only 42 percent have seen a decline in their healthcare facility-associated CDI rates during that time period; 43 percent have not seen a decline. While CDI rates have climbed to all-time highs in recent years, few facilities (21 percent of respondents) have added more infection prevention staff to address the problem.  

APIC conducted the 2013 CDI Pace of Progress survey in January 2013 to assess activities that have been implemented in U.S. healthcare facilities in the last three years to prevent and control CDI, a healthcare-associated infection that kills 14,000 Americans each year. A total of 1,087 APIC members completed the survey which was intended to provide a general overview of trends and indicate areas where more in-depth research might be beneficial. The findings were presented today at APIC’s Clostridium difficile Educational and Consensus Conference in Baltimore, Md.

“We are encouraged that many institutions have adopted stronger measures to prevent CDI, but as our survey indicates, more needs to be done to reduce the spread of this infection,” said Jennie Mayfield, BSN, MPH, CIC, APIC president-elect and clinical epidemiologist at Barnes-Jewish Hospital. “We are concerned that staffing levels are not adequate to address the scope of the problem.”

The Pace of Progress survey also noted an inconsistency between cleaning efforts and monitoring. More than nine in 10 respondents (92 percent) have increased the emphasis on environmental cleaning and equipment decontamination practices since March 2010, but 64 percent said they rely on observation, versus more accurate and reliable monitoring technologies to assess cleaning effectiveness. Fourteen percent said that nothing was being done to monitor room cleaning. 

“Because C. difficile spores can survive in the environment for many months, environmental cleaning and disinfection are critical to prevent the transmission of CDI,” said Mayfield. “Environmental Services must take the lead in developing aggressive programs to monitor cleaning practices and then ensure that the results are shared with front-line staff. Without that buy-in, practices are unlikely to improve.” 

According to the survey, antimicrobial stewardship programs are slowly increasing. Sixty percent of respondents have antimicrobial stewardship programs at their facilities, compared with 52 percent in 2010. Because antimicrobial use is one of the most important risk factors for CDI, stewardship programs that promote judicious use of antimicrobials should be encouraged. 

Nearly four out of five respondents have used the APIC Implementation Guide on CDI to help identify or guide improvements. APIC has released a second, expanded edition that showcases tools and resources for prevention programs.

“We look forward to the dialog at our conference among government leaders, clinical experts, public health professionals, and infection preventionists,” said Katrina Crist, APIC CEO. “Working together we will identify knowledge gaps and research needs so that we can chart the steps toward stopping transmission of this infection.” 

According to the Centers for Disease Control and Prevention, deaths related to CDI increased 400 percent between 2000 and 2007, due in part to a stronger germ strain. CDI is estimated to add at least $1 billion annually to U.S. healthcare costs.

The Clostridium difficile Educational and Consensus Conference, hosted March 11-12 by APIC, brings together government leaders and infection prevention experts to evaluate the impact of efforts to prevent and control CDI. The hashtag for the conference is #cdiff2013.

APIC’s mission is to create a safer world through prevention of infection. The association’s more than 14,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at www.apic.org. Follow APIC on Twitter: http://twitter.com/apic