Survey Finds US Hospitals Falling Short on Preventing C. Difficile Infection

A survey of 571 US hospitals regarding practices used to prevent Clostridium difficile infection (CDI) indicates that nearly half of the facilities appear to not be taking steps to prevent the infection that kills nearly 30,000 people and sickens hundreds of thousands more each year, despite strong evidence that these steps work.

Although nearly all hospitals in the study—published online in Infection Control & Hospital Epidemiology—used multiple measures to protect their patients from CDI, 48% hadn’t adopted strict limits on the use of antibiotics and other drugs that can allow C. diff to flourish. Programs to monitor for CDI, protective gear, separate hospital rooms, and special cleaning techniques when treating a patient with a CDI were in place in virtually all hospitals to avoid transmission.

Yet, the lack of antimicrobial stewardship programs persisted in nearly half, even with almost all infection control leaders who were surveyed agreeing that these efforts are proven to prevent CDIs.

What’s more, the study team observed a large deficit in written policies to test patients for CDI if they have developed diarrhea while taking antibiotics or within several months of taking antibiotics. In fact, almost 75% of hospitals didn’t have these policies.

“C. diff infection over the last decade has emerged as a threat to patients, especially the most vulnerable and the elderly, and has increased in incidence and severity,” said lead author Sanjay Saint, MD, MPH, George Dock Professor of Internal Medicine, Department of Internal Medicine, University of Michigan. “There are many ways to try to limit the spread, and from our data it looks like hospitals are aware of the evidence behind them and acting on many where they believe the evidence is strong. But the one area where there's a major disconnect between evidence and practice is antimicrobial stewardship, or limiting antibiotics to use only when necessary. This is a real opportunity for improvement.”

Indeed, more than 60% of hospitalized patients receive antibiotics, as much as 50% of which has been shown in other studies to be inappropriate. Reducing antibiotic use in hospitals can not only reduce the risk of CDI, but also the change for bacteria to develop antibiotic resistance, said Dr. Saint.

“The doctors who prescribe most of these antibiotics, and who would have to buy in to stewardship programs, are hospitalists,” said Saint. “Nationally, they're the ones we must engage with to overcome this disconnect between what people think works and what they're actually doing, and to implement stewardship programs. This is about changing physician behavior and that makes it more challenging.”