One hospital wins a round against C. diff
When officials at the Jewish Hospital-Mercy Health in Cincinnati launched a high-priority initiative in 2009 to bring down its skyrocketing C. diff rate, it took far less time and money than they expected to get dramatic results.
With better controls on antibiotic use, new room-cleaning strategies, and revamped standards of care, the hospital cut its C. diff infection rate 50% in just six months -- a period when the average number of cases dropped from about 16 a month to fewer than half that number. And the decline continues: From January through March this year, the infection rate was down nearly 80% since the initiative began, with no change in occupancy rates.
"We weren't inventing anything new with this project -- it was based on science, it was based on evidence, on best practices that were in the literature," says Azalea Wedig, the hospital's infection- control specialist. "We didn't think we'd see such drastic results in six months."
Wedig realized the hospital's C. diff rates had reached a critical level in April 2009, after reading new academic research that outlined a new way to assess C. diff prevalence among patient populations. The study ranked incidence rates in three categories: tolerable, concern and alarming.
"Our numbers weren't just close to being at the alarm level; we were above the alarm level," Wedig says.
The rates were especially worrisome because about two-thirds of Jewish Hospital's patients are elderly. People older than 65 account for about 90% of all deaths from C. diff infections, federal data show.
The hospital set up a multidisciplinary team to develop strategies to attack the problem. Led by an infectious-disease doctor, the 20-person group included hospital pharmacists, the director of housekeeping, leaders from the nursing and medical staffs, and administrators.
The team built a timeline for implementing protocols and set specific C. diff reduction targets.
Among the changes:
Rapid identification and isolation. Anyone admitted to the hospital with diarrhea and a recent history of using antibiotics or other drugs linked to C. diff infections is isolated immediately and tested for the bacteria. New protocols allow nurses -- instead of just doctors -- to order C. diff tests for symptomatic patients.
Controls on antibiotic use. Pharmacists monitor the use of all drugs known to foster C. diff infections and track prescriptions used by patients who contract C. diff-related illnesses. Physicians are trained in strategies for limiting antibiotic use and educated on the ways particular drugs can promote the infection.
Training for medical and support staff. Programs on C. diff and hygiene issues, such as how to wash hands, are provided for all personnel who interact with patients. Room-cleaning staff get regular training on disinfecting high-touch surfaces, proper use of cleaning products and other decontamination measures.
New room-cleaning practices. Rooms and wards with C. diff patients are cleaned more frequently than others, using dedicated toilet brushes, microfiber mops and rags, and bleach-based disinfectants. Room-cleaning audits are done with a sensor that assesses whether surfaces were wiped properly.
No extra workers were hired, so the initiative's price tag was relatively modest: about $5,000 in start-up costs, mostly for devices to audit room cleanings, and $10,000 a year for everything from equipment to educational materials.
Multipronged approaches to combating C. diff have proved effective in cutting infection rates at all sorts of health care facilities, says Irena Kenneley, an infection specialist and assistant professor of nursing at Case Western Reserve University.
"We've seen that no single intervention will suffice; there are a lot of things that have to happen," she says. Hospitals with fewer resources, often in poor or rural areas, face more challenges in setting up such programs, she adds, noting that many may not have an infectious disease specialist. "It's a lot of work, but it needs to be done."
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