Poll Reveals Hospitals' Difficulties Staffing for C. Difficile

Despite additional measures being taken to prevent and control the spread of Clostridium difficile infection (CDI) within national health care institutions, a third of infection preventionists surveyed believe their facilities should be doing more to prevent this sometimes deadly intestinal infection.

According to a survey conducted recently by the Association for Professionals in Infection Control and Epidemiology (APIC), 53 percent of respondents report adopting additional measures to control the spread of CDI in the last 18 months. Less than a quarter, however, have been able to add more infection prevention staff.

APIC conducted the 2010 CDI Pace of Progress poll to determine if hospitals have increased interventions to prevent CDI in the 18 months since the 2008 APIC CDI prevalence study revealed CDI rates to be six to 20 times greater than previous estimates.

A cause of diarrhea and more serious intestinal conditions, CDI is frequently associated with previous antibiotic use and is most commonly contracted by the elderly and those with recent exposure to hospitals, nursing homes, and other health care institutions. A more severe strain of CDI appeared in the early 2000s and has been associated with a higher number of treatment failures and deaths.

According to the survey, institutions that have not added interventions believe their rates of CDI are under control: 45 percent said CDI was not identified as a high-priority problem for their facility, 34 percent have an infection control plan to increase interventions in the event of an outbreak, and 30 percent said that CDI rates were declining with current practices.

"We are pleased to see that many healthcare institutions have strengthened their efforts to combat CDI and that many have seen declines due to these added measures," said APIC CEO Kathy Warye. "But we are concerned that three out of four respondents may not have adequate staff and resources to protect patients. We had hoped that the infection prevention positions and resources that were eliminated during the economic downturn would have been replaced by this time."

APIC's 2010 CDI Pace of Progress poll indicates that institutions are using multiple strategies, as recommended, to address CDI:

  • 83 percent of respondents currently have hospital-wide hand hygiene initiatives
  • 90 percent perform surveillance or conduct activities to promptly identify CDI cases
  • 94 percent always place patients with CDI on Contact Precautions, meaning they isolate patients suspected of having CDI, and healthcare professionals use gowns and gloves when caring for them
  • 86 percent have increased their emphasis on environmental cleaning

Fewer than 30 percent of respondents, however, monitor the number of colectomies at their institutions, which is an indicator that the more severe strain of CDI may be present. Nearly a quarter of respondents do not monitor the effectiveness of their environmental cleaning efforts. In previous surveys, APIC members have cited lack of staff time and resources as the reason these measures have not been implemented.

The CDI Pace of Progress report also identified antimicrobial stewardship as an area for improvement. Four in 10 respondents do not have programs that promote the judicious use of antimicrobials, and only a third of respondents have increased the monitoring and evaluation of antimicrobial use during the last 18 months.

"Because up to 90 percent of patients with symptomatic CDI have previously received antibiotics, stewardship programs that seek to limit inappropriate use of these agents play an important role in CDI prevention efforts and are necessary to prevent antimicrobial resistance, which is a growing worldwide concern," said APIC President Cathryn L. Murphy, RN, Ph.D., CIC. "Further research is needed to develop effective stewardship programs."

Additionally, the Pace of Progress report noted differences in practices for hand hygiene, isolation, environmental cleaning and monitoring, and CDI testing and surveillance.

"The variation in some of the practices identified in the report provide an invaluable roadmap to improve standardization of prevention measures and guide future research about preventing CDI," Murphy said.

According to the World Health Organization, on any given day, more than 1.4 million patients are affected by a health care-associated infection (HAI). In the U.S., HAIs are associated with an estimated 99,000 deaths and incur $30 to 40 billion in excess healthcare costs annually.

APIC conducted the online CDI Pace of Progress poll February 19 – March 10, 2010; 1,766 out of 13,000 APIC members responded. Three-quarters of survey respondents work at acute care hospitals. Responses were received from all sizes of facilities and hospitals. Visit www.apic.org to see the full report.

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