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400% The increase in deaths linked to C. difficile infections between 2000 and 2007. Vital Signs www.cdc.gov/vitalsigns

  
Clostridium Difficile is a dangerous and unfortunately, common hospital acquired infection which can cause life-threatening diarrhea.  It is highly contagious and can easily be spread by hospital staff and patients in an acute care facility. 

The Journal of Infection Control reported in May of 2009 that the overall C. Difficile prevalence rate in acute care facilities was 13.1 per 1000 inpatients (94.4% infection.)1,2  This was a rate 20 times more than expected.2  The incidence in individual states varied from  zero in Hawaii to 28.88 in Rhode Island.2

CDC Vital Signs:  Stopping C. Difficle Infections
   

        
  MRSA Infections
  C. Diff.  Infections
  CLABSI Infections
  CAUTI Infections
  VAP  Infections
  Prevention of Events

The increase in incidence of C. Diff is felt to be due to increased antibiotic usage, an aging population, associated chronic disease, the emergence of strains resistant to the fluoroquinolones (cipro) and the emergence of hypervirulent strains.  Like the MRSA epidemic, there is now an emergence of a community acquired strain of C. Diff.3   Approximately 2.2% of patients will die from the infection and 1% will require a colectomy.3   If a colectomy is required, the mortality rate is approximately 33%.3 

    CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

C. Diff. is a spore forming bacteria and hard to kill.  It is resistant to alcohol and ammonium.   Bleach is the best agent to clean surfaces and hands should be washed with soap and water.  Alcohol dispensers will not kill the spores but soap and water will mechanically remove them.  Hand washing with soap and water is more effective than using alcohol-based hand rubs in removing C. Diff.4,5

Healthcare workers at the Mayo Clinic have reported that daily cleaning of hospital rooms with bleach has been reported to decrease the incidence of C. Difficile infection.6  Using similar methodology, a hospital in Lancaster, PA reduced the incidence of C. Difficile infection by 50%.

It is not known whether probiotics use can decrease the incidence of C. Diff.8   However, they will often help with the prevention of antibiotic induced diarrhea.  

Finally, it is known that reducing gastric Ph and secretions with the use of H2 blockers and proton pump inhibitors increases the chances of acquiring C Diff.9

View News Article in the Washington Post on C. Diff.

VA Uses a Three Tiered Approach to Clean Rooms of C. Difficile Patients. Standard CDI terminal cleaning procedures of C. Difficile rooms reduced the incidence of positive cultures from the rooms to only 67%. However in a tiered analysis, it was required to use facility-wide fluorescent markers to evaluate the effectiveness of cleaning, UV device use for CDI rooms and enhanced daily and terminal disinfection for CDI rooms. Using this three tiered approach the percentage of positive cultures dropped to 7%.10 http://www.jstor.org/stable/10.1086/670217   

New Research Indicates that Patient's With Symptoms of C. Difficile Should be Isolated While Awaiting Culture Results.  The current guidelines only recommends isolation for all patients with culture proven C. Difficile.11
http://www.ncbi.nlm.nih.gov/pubmed/23388367

Clostridium Difficile Infections (CDI) Linked to Exposure With Healthcare Delivery Systems.
"Most patients with community-associated CDI had recent outpatient health care exposure, and up to 36% would not be prevented by reduction of antibiotic use only."
http://archinte.jamanetwork.com/article.aspx?articleid=1697791

Patient Tip:  C. Difficile is not killed by alcohol rubs or swabs.  Staff need to use soap and water to mechanically remove spores, the bathroom and patient room should be cleaned with Clorox (Bleach).  It is important to clean the room with Clorox (Bleach) between patients.   
    

References

  1. Jarvis WR, Schlosser J, Jarvis AA, Chinn RY. National point prevalence of Clostridium difficile in US health care facility inpatients, 2008. Am J Infect Control. 2009 May;37(4):263-70. Epub 2009 Mar 10.  http://www.ncbi.nlm.nih.gov/pubmed/19278754  

  2. Prevalence of C. diff in hospital patients American Medical News. June 1, 2009.   http://www.ama-assn.org/amednews/2009/06/01/prca0601.htm   

  3. Sahil Khanna and Darrell S Pardi The Growing Incidence and Severity of Clostridium Difficile Infection : Severity & Burden of Disease Expert Review of Gastroenterology and Hepatology 2010;4(4):409-416 Aug. 25, 2010. http://www.medscape.com/viewarticle/726904   

  4. Jabbar U, Leischner J, Kasper D, Gerber R, Sambol SP, Parada JP, Johnson S, Gerding DN. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol. 2010 Jun;31(6):565-70.  http://www.ncbi.nlm.nih.gov/pubmed/20429659   

  5. Robert C. Owens Clostridium difficile-Associated Disease: The Environment Medscape General Surgery Pharmacotherapy. 2006;26(3):299-311. http://www.medscape.com/viewarticle/529165   

  6. Mayo Clinic. "C. Difficile: Intervention Drops Hospital Infection Rate by a Third." ScienceDaily 30 March 2010. 28 August 2010  http://www.sciencedaily.com/releases/2010/03/100319142658.htm  

  7. Brosey L and Garrety S. Adherence Reduces C.diff Hospitals in Pursuit of Excellence. http://www.hpoe.org/case-studies/6872357931   

  8. Hsu J, Abad C, Dinh M, Safdar N. Prevention of Endemic Healthcare-Associated Clostridium difficile Infection: Reviewing the Evidence. Am J Gastroenterol. 2010 Jul 6. [Epub ahead of print]   http://www.ncbi.nlm.nih.gov/pubmed/20606676    

  9. Howell MD, Novack V, Grgurich P, Soulliard D, Novack L, Pencina M, Talmor D. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010 May 10;170(9):784-90. http://www.ncbi.nlm.nih.gov/pubmed/20458086  

  10. Sitzlar B, Deshpande A, Fertelli D, Kundrapu S, Sethi AK, Donskey CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol. 2013 May;34(5):459-65. doi: 10.1086/670217.   
    http://www.ncbi.nlm.nih.gov/pubmed/23571361    

  11. Sunkesula VC, Kundrapu S, Jury LA, Deshpande A, Sethi AK, Donskey CJ. Potential for transmission of spores by patients awaiting laboratory testing to confirm suspected Clostridium difficile infection. Infect Control Hosp Epidemiol. 2013 Mar;34(3):306-8. doi: 10.1086/669510. Epub 2013 Jan 23. 
    http://www.ncbi.nlm.nih.gov/pubmed/23388367