C Diff Infections Common Outside Hospitals

Earlier estimates of 337,000 annual U.S. hospital stays related to C. difficile actually understate its overall impact.

Infections from Clostridium difficile (C. difficile), a bacteria that causes diarrhea and other health issues, are a patient safety concern in all types of medical facilities, not just hospitals as traditionally thought, according to a March 6 Vital Signs report from CDC. Many other health care-associated infections declined in the past decade, but C. difficile infection rates and deaths climbed to historic highs.

"C. difficile harms patients just about everywhere medical care is given," CDC Director Dr. Thomas R. Frieden, M.D., MPH, said. "Illness and death linked to this deadly disease do not have to happen. Patient lives can be saved when health care providers follow the six steps to prevention, which include key infection control and smart antibiotic prescribing recommendations."

The steps are:

  • Prescribe and use antibiotics carefully. About 50 percent of all antibiotics given are not needed, unnecessarily raising the risk of C. difficile infections.
  • Test for C. difficile when patients have diarrhea while on antibiotics or within several months of taking them.
  • Isolate patients with C. difficile immediately.
  • Wear gloves and gowns when treating patients with C. difficile, even during short visits. Hand sanitizer does not kill C. difficile, and handwashing may not be sufficient.
  • Clean room surfaces with bleach or another EPA-approved, spore-killing disinfectant after a patient with C. difficile has been treated there.
  • When a patient transfers, notify the new facility if the patient has a C. difficile infection.

C. difficile is linked to about 14,000 U.S. deaths every year. People at highest risk are those who take antibiotics and also receive care in any medical setting. Almost half of infections occur in people younger than 65, but more than 90 percent of deaths involve people 65 and older. Earlier estimates based on billing data show the number of U.S. hospital stays related to C. difficile remains at historically high levels of about 337,000 annually, adding at least $1 billion in extra cost to the health care system, but the report shows the overall impact is higher.

While 94 percent of C. difficile infections are related to medical care, about 25 percent first show symptoms in hospital patients and 75 percent first show in nursing home patients or in people recently cared for at doctors' offices and clinics. "Although the proportion of infection onset is lower in hospitals, these facilities remain at the core of prevention since many patients with C. difficile infections are transferred to hospitals for care, raising risk of spread within the facility," it says, adding that half of C. difficile infections diagnosed at hospitals already were present when the patient was admitted, usually after getting care in other facilities. The other half were related to care given in the hospital where the infection was diagnosed.

Hospital programs in Illinois, Massachusetts, and New York cut their infections by 20 percent by following infection control recommendations, and similar efforts in England cut its infections by more than 50 percent during a recent three-year period.

"C. difficile infections are usually a regional problem since patients transfer back and forth between facilities, allowing the disease to spread," said L. Clifford McDonald, M.D., a CDC medical epidemiologist and lead author of the study. "Health departments have the ability to work with many types of health care facilities, and have a unique opportunity to coordinate local, comprehensive prevention programs to reduce the occurrence of these infections."

For more information about preventing C. difficile, visit http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html.

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