—Dr. L. Clifford McDonald
Prevention and Response Branch Chief in CDC’s Division of Healthcare Quality Promotion
In this blog series, I would like to talk about a healthcare-associated infection (HAI) that I have spent a good portion of my career tackling – Clostridium difficile (C. difficile, or C. diff for short). C. difficile is a bacterium that causes a range of potentially serious intestinal conditions such as diarrhea and colitis. Unfortunately, people who are most at risk for C. diff infections are also the most vulnerable, such as the elderly and other hospitalized patients.
In short, C. difficile is having a major impact on healthcare. It causes 500,000 infections each year, resulting in nearly 30,000 deaths and costing the system almost $4 billion a year. We at CDC believe that an especially strong, widespread epidemic strain is the cause of many of these infections.
A major risk factor for C. diff infection is recent antibiotic use, as these drugs upset the balance of bacteria in the gut and allow C. diff entering the body to grow aggressively. In fact, 90% of C. diff infections occur in people who recently took antibiotics. People become infected when they touch things that are contaminated with feces and then touch their mouth or face. Healthcare workers can spread the bacteria to patients or contaminate surfaces through hand contact. Although most of our research shows that only people who are hospitalized or who are on antibiotics are likely to become ill, any person who is infected can spread the organism to any other person.
There are several national and local efforts underway to prevent C.difficile infections. These include:
- CDC Prevention Epicenters Collaborative in Ohio. Over 50 hospitals are working together in the state of Ohio to assess & prevent CDI. Early results from that effort can be seen here.
- National CDI collaborative with the US Department of Veterans Affairs.
- Project with AHRQ and academic partners to reduce CDI rates by decreasing unnecessary antimicrobial prescribing. This will result in an implementation toolkit and manual to assist other regional prevention collaboratives in reducing CDI rates.
- Partnership with Centers for Medicare & Medicaid Services (CMS) on a Quality Improvement Organizations pilot intervention targeting CDI
- Health Care Improvement Foundation (HCIF)’s Southeast PA Regional Partnership for Patient Care Collaborative, C.difficile prevention *
Next week, colleagues from APIC will discuss how infection preventionists are tackling C. difficile, and SHEA will dive more into antibiotics’ role in C. diff. In the meantime, I am interested to hear your thoughts on C. diff and how to best prevent these infections.