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Clostridium Difficile

Many types of health care associated infections are declining, however, one caused by the germ Clostridium difficile (C. difficile) remains at high levels. The intestines have many “good” germs in them that help digest food. C. difficile germs enter the body by eating or swallowing something that has C. difficile on it. The germ then moves to the intestines. A healthy person with a normal immune system and normal “good” germs may not get sick. But if the immune system is weak or these good germs have been killed by an antibiotic taken for a different infection, C. difficile may grow in the intestines.

Patients have a greater risk for getting a C. difficile infection if they:

  • Have taken an antibiotic during the past 30 days. Antibiotics can kill the “good” germs in your intestines.
  • Have an immune system that is weak from a major chronic (ongoing) illness.
  • Are a woman 65 or older.
  • Take medicine for heartburn or to lower the acid in your stomach. These medicines include Prevacid®, Tagamet®, Prilosec®, or Nexium®.
  • Have been in the hospital, especially in an intensive care unit
  • Live in a nursing home.

C. difficile infections occur most often in hospitals, nursing homes, and other places where there are more people who are sick and who are taking antibiotic medicines.

C. difficile can be mild, moderate, or severe. C. difficile causes abdominal cramps and diarrhea, and as it becomes more severe it can cause bloody stools, frequent diarrhea and dehydration. It has been linked to death in some patients.

Half of all hospital patients with C. difficile infections have the infection when admitted and may spread it within the facility. C. difficile is picked up from contaminated surfaces or spread from anyone’s hands. This could be the hands of a healthcare provider, the patient, or a visitor. Diarrhea is the most likely source of spreading C. difficile.

http://www.cdc.gov/VitalSigns/Hai/StoppingCdifficile/

At JFK we use best practice infection control procedures to prevent the spread of C. difficile from patient to patient. C. difficile germs can remain on bed linens, bed rails, bathroom fixtures, and medical equipment. Infection control practices to prevent the spread of C. difficile include:

  • Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while in the room. There is an orange sign on the patient door to notify anyone entering the room that they must use gowns and gloves.
  • Thorough cleaning. C. difficile spores can survive routine cleaning products that do not contain bleach. Therefore, surfaces are carefully disinfected with a product that contains chlorine bleach. In addition, we use a state of the art ultraviolet machine as part of our room disinfection procedures.
  • Hand-washing. Everyone should practice good hand hygiene before and after treating each person in their care. When C. difficile is present, soap and warm water is the first choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy C. difficile spores. Visitors also should wash their hands with soap and warm water before and after leaving the room.
  • Avoid unnecessary use of antibiotics. An antibiotic stewardship program directed by pharmacists and infection control physicians promotes the appropriate use of antibiotics in the hospital.

http://www.mayoclinic.org/diseases-conditions/c-difficile/basics/prevention/con-20029664

What are we measuring?

We measure the number of hospital onset C. difficile infections. This does not include patients who come to the hospital with C. difficile. Below is a graph of the number of patients with hospital onset C. difficle infections over time.

201607-cdiff1

Hospital Compare uses another way to display hospital onset C. difficile infections. A standardized infection ratio (SIR) is used. Standardized infection ratios compare the actual rate of infection to the predicted rate. The standardized infection ratio (SIR) is a summary measure used to track C. difficile at a national, state, or local level over time. The SIR adjusts for the fact that each healthcare facility treats different types of patients.

A SIR significantly greater than 1.0 indicates that more hospital onset C. difficile infections occurred than were predicted. An SIR significantly less than 1.0 indicates that fewer hospital onset C. difficile infections occurred than predicted.

The next graph shows SIRs for JFK, the state of New Jersey, and the Nation.

201607-cdiff1

What is our performance telling us?

The graph above titled Number of hospital onset C. difficile Cases shows the number of hospital onset cases of C. difficile infection decreasing over time until June 2016. In June of 2016 we began to use a test for C difficile that is more sensitive and we believe that this may account for the increase in Hospital Onset cases. However, we take this seriously and have several new processes in place to stop the spread of c difficile. A team of professionals evaluates every new case of C difficile on the same day the laboratory test is reported. Additional steps to stop the spread of C difficile include additional cleaning processes, pharmacist review of the use of certain medications, revised procedures for identifying c difficile, and a hospital wide hand washing campaign.

We continue our focus on strict precautions, disinfecting the environment, and educating patients and visitors about their role in prevention. We are working every day to decrease and ultimately eliminate these infections. Preventing hospital acquired C. difficile is one of our highest priorities. Our goal is to eliminate the spread of C. difficile in the hospital.

The graph above titled C difficile Standardized Infection Ratio (SIR) JFK compared with NJ and the Nation shows that JFK was below (better than) the state and national SIR for hospital onset C. difficile infections in 2014 and 2015. Comparative SIR data for the full year 2016 for NJ and the Nation is not yet available.

What can you do to reduce the chance of getting a C difficile infection in the hospital?

Do not be embarrassed or afraid to ask any case giver if they have washed their hands.

If you are a patient, wash your hands frequently and always after using the bathroom and before eating.

Visitors must wash their hands before they enter a patient’s room and when they leave the patient room. In addition, visitors should wash before and after any contact with the patient or anything in the patient’s room.

If you are visiting a patient in a room with an orange contact precaution sign ask the nursing staff for help with gowns and gloves before entering the patient room.

Tell your nurse or physician if you develop diarrhea while in the hospital. This may be the first sign of C difficile.

Preventing the spread of C.difficile at home.

When someone in the household has diarrhea caused by a C. difficile infection, the most effective and simplest method to prevent its transmission is for the patient and members of the family to wash their hands regularly and well with soap and water, rinse well, and dry completely. Always wash before eating and after using the toilet.

Certain objects and surfaces often touched by the patient may be contaminated. Therefore, the patient's room and the bathroom should be cleaned more frequently, using liquid bleach (1 part liquid bleach diluted in 9 parts water).

Clothes may be washed as usual, using regular detergent and hot or warm water.

If your family members provide personal care to you while you have C. difficile diarrhea, they should take precautions, wear gloves, and wash hands afterward. If clothes or bedding become soiled, wash them in the washing machine with hot soapy water.

http://www.lahey.org/

http://www.msss.gouv.qc.ca