Clostridium difficile Rates on the Rise in Illinois

A recent report from Illinois (C. diff Report) indicates that C. difficile rates have more than doubled in the last decade, while MRSA rates have remained steady throughout the last three years.  C. difficile is one of many GI bacteria that account for a significant percentage of the more than 2 million preventable HAI’s, and excess costs of  up to $45 billion in the U.S. annually.

Hand hygiene and antibiotic control have long been the primary components of Infection Control processes aimed at preventing HAI’s, including those caused from GI bacteria like C. difficile , VRE, and E. coli.  Though these are 2 critical components of an overall infection prevention program, growing prevalence of HAI’s over the past 2 decades reinforce the need for a more comprehensive approach that seeks to identify sources of infection risks and implement strategies to interrupt the transmission of bacteria and pathogens throughout a hospital environment.  Identifying potential sources of infectious bacteria like C. difficile , like those implemented for bloodborne pathogens at the onset of the HIV epidemic, is a critical and often overlooked step in establishing comprehensive infection prevention and patient safety protocols.

10 Facts You Should Know About C. Difficile :
1.  The GI tract is the known source (origin) of C. difficile
2. Risk factors for CDAD include advanced age, GI procedures and manipulations, antibiotic exposure, and immunosuppression
3.  C. difficile can be predictably encountered (even in asymptomatic patients) when and where GI secretions are present. (i.e. bathrooms, incontinent patients, rectal lab test materials, GI/endoscopy procedures)
4.  C. difficile can survive on environmental surfaces for 5 months or longer
5.  C. difficile is transmitted via the fecal-oral route from environmental or source surfaces to people (patients, staff, visitors)
6.  Alcohol-based hand sanitizers are not effective against C. difficile spores
7.  Most hospital disinfectants are not active against C. difficile unless they contain bleach
8.  CDAD results when beneficial bacteria in the GI tract is altered by antibiotics and PPI’s, but it takes both exposure to these drugs and the presence of C. difficile to cause infection
9.  CDAD risks and prevalence continue to rise despite more than 2 decades of focus on hand hygiene and antibiotic control, evidencing that more needs to be done to interrupt sources and transmission in healthcare facilities
10.  Mortality rates for patients developing CDAD can be greater than 40%, with recurrence in up to one third of patients following an initial CDAD infection.

Current infection trends and the rising prevalence of highly resistant strains of C. difficile reinforce the need to enhance focus on preventing and controlling opportunities for cross transmission of infectious pathogens in health care environments.  While adequate hand hygiene and judicious use of antibiotics are important components of an overall infection prevention strategy, facilities who rely on these exclusively will remain “behind the curve” in proactively reducing risks of exposure and infection.  Experiences and process changes implemented during the HIV epidemic in the 1980′s resulted in a high level of effectiveness in identification and risk reduction for activities during which blood or blood products were encountered during the delivery of patient care.  As a result, occurrences of transmission of bloodborne pathogens like  HIV/HBV in the healthcare has been drastically reduced, and are almost always associated with a breach in protocols and common sense practices.  The same is equally attainable with infectious pathogens like C. difficile  and similar bacteria by identifying  learning opportunities and correcting weak links in a facility wide exposure control plan.