Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion
Looking back now, it is like a movie playing out in my mind. We were at the 2004 IDSA conference in Boston, and my colleagues from the CDC lab, Dr. Dale Gerding’s laboratory, other scientific collaborators, and I were presenting on a new strain of Clostridium difficile called NAP1. I’m not sure everyone understood the implications. Some realized NAP1 could be big; others felt that C. diff wasn’t that big of a deal. For me, it was like seeing a train coming, and you can’t get off the tracks.
Clostridium difficile infections have been an important part of my career. Upon wrapping up the SARS investigations for CDC in Toronto, I turned my attention to C. difficile, as I sensed there was something going on that needed further investigation. Now, here we are 8 years later, and NAP1, which causes severe infection, is still a major issue in the United States.
C. difficile has become a problem across medical care settings. So much so that the March issue of CDC’s Vital Signs report highlights these deadly infections. The report shows that C. difficile is causing many Americans to suffer or die. Although other healthcare-associated infections (HAIs) have declined in recent years, C. difficile has climbed to historic highs and remains at unacceptable levels. It also points out that C. difficile is no longer just a problem in hospital settings; these infections are a patient-safety concern everywhere medical care is provided.
However, there is good news — these infections can be prevented. Prevention programs in Illinois, Massachusetts, and New York are all reporting 20% declines in hospital C. difficile infection rates as a result of focused infection prevention efforts.
Looking ahead, I foresee the trend lines in hospitalizations and deaths turning around and coming back down. A realistic, near-term goal is to return C. diff infection rates back to where they were before the arrival of NAP1 (1999). Our long-term goal is to pursue the discovery of new prevention methods, which will continue to move us toward the ultimate goal of elimination. By focusing first on the following, we can get there: 1) use antibiotics carefully, 2) detect C. difficile early, 3) isolate patients who test positive immediately, 4) use gloves and gowns to treat, and 5) when patients transfer to another facility, be sure to let the receiving medical team know if the patient has a C. difficile infection. Facilities can also prevent C. difficile by ensuring the cleaning staff uses an EPA-approved, spore-killing disinfectant to clean rooms where C. difficile patients are treated.
Over the past 8 years as C. difficile has marched on, it has been a formidable foe. But there is reason for real encouragement in our ability to combat it. Today, we have tools that we simply didn’t have available at that time. As a country, we have a new-found ability to mobilize to address these deadly HAIs. We are finally at a place where public health is interfacing with healthcare delivery. As a result, I have real optimism in our ability to combat this adversary.
What is your facility doing to prevent the spread of deadly Clostridium difficile infections?