Hospitals not doing all they can to prevent C diff infections

Dr SaintNearly half of American hospitals aren’t taking key steps to prevent Clostridium difficile infection-despite strong evidence that such steps work, according to a new study published online in Infection Control & Hospital Epidemiology.

The current study was part of an ongoing panel survey that began in 2005 when researchers from the University of Michigan Medical School and VA Ann Arbor Healthcare System asked hospitals across the United States what practices they are using to prevent common healthcare-associated infections.

WATCH: Sanjay Saint, MD, MPH, interview on hospital-acquired infections

Sanjay Saint, MD, MPH, chief of medicine, VA Ann Arbor Healthcare System, George Dock Professor of Internal Medicine, University of Michigan Medical School (U-M), and his colleagues from the Patient Safety Enhancement Program, a joint U-M and VA Ann Arbor Healthcare System program, surveyed infection control leaders at hospitals, as part of an ongoing project that started in 2005. They asked hospitals what practices they are using to prevent common healthcare-associated infections. More than 70% of the 571 hospitals that received the survey answered it.

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The survey sample included a stratified random sample of non-federal general medical and surgical hospitals with 50 or more beds and with intensive care beds. Surveys were mailed to all hospitals along with a cover letter, a pre-paid return envelope, and a $10 incentive. Survey reminders were sent after the initial mailing. The present survey included questions related to C diff infection prevention. Respondents were asked how frequently certain C diff infection practices were used for adults in their acute care facility.

“Healthcare-associated infections are common, costly and potentially life-threatening.  The findings of this study highlight that a key prevention practice for C diff infection-antimicrobial stewardship-is lacking in about half of US hospitals despite the perceived high strength of evidence to support such programs,” according to Dr Saint.

NEXT: 3 steps formulary managers can do

“First, most US hospitals reported using a surveillance system to monitor for C diff infections among their patients.  Second, reported use of several recommended practices is very high, along with the corresponding perceived strength of evidence for many of these practices. Finally, the gap between our respondents’ reported regular use of antimicrobial stewardship and their perceived strength of evidence to support antimicrobial stewardship was the highest of any practice.”

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According to Dr Saint, there are 3 steps formulary managers can do to help prevent infection:

• Promote and help adopt appropriate surveillance mechanisms to identify healthcare-associated infections and track progress of implemented programs.

• Based on the results of the surveillance mechanism, help (and perhaps lead) the development and implementation of an antimicrobial stewardship program that will develop a database maintaining antimicrobial use, sensitivity and outcomes.

• Take an interdisciplinary approach to developing a plan of action in the use and delivery of antibiotics.

Healthcare-associated infections are a major cause of illness and death in hospitalized patients and preventing healthcare-associated infection is a global challenge, according to Dr Saint.

NEXT: Prevalence of hospital-acquired infections

According to the World Health Organization, worldwide, the prevalence of healthcare-associated infections in developed countries and undeveloped countries range from 5.1% to 11.6% and 5.7% to 19.1%, respectively. In the United States, roughly 2 million such infections occur annually, resulting in approximately 99,000 deaths and estimated annual direct medical costs ranging between $28.4 and $33.8 billion.

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Last fall, the White House set a goal of reducing C diff infections by 50% by 2020, as part of its

. The Centers for Disease Control and Prevention has also targeted C. diff as a key threat to public health. And hospitals’ C diff infection rates among Medicare participants are publicly reported on the Hospital Compare website operated by the U.S. Department of Health and Human Services.

Sanjay Saint, MD, MPH, chief of medicine, VA Ann Arbor Healthcare System, George Dock Professor of Internal Medicine, University of Michigan Medical School (U-M), discusses hospital-acquired infections and ways to prevent them.