Some Hospitals Not Doing Enough to Protect Patients From Infection

By Sondra Forsyth

Almost half the hospitals who took part in a study aren’t doing what they should to prevent Clostridium difficile bacteria, which sickens hundreds of thousands of people each year.

While nearly all of the 398 hospitals in the study use a variety of measures to protect their patients from C. diff infections, a team of investigators from the University of Michigan Medical School and VA Ann Arbor Healthcare System reported that 48 percent haven’t adopted strict limits on the use of antibiotics and other drugs that can allow the dangerous bug to flourish.

Hospital patients are especially prone to developing C. diff infections, and suffering its serious effects — especially after they take antibiotics that disrupt the community of bacteria in their digestive systems, according to a university news release.

The findings were published Infection Control & Hospital Epidemiology.

Virtually all the hospitals had programs to monitor for C. diff infections, and use protective gear, separate hospital rooms and special cleaning techniques when treating a C. diff-infected patient, so that it doesn’t spread to other patients. In addition to being present in bodily fluids, C. diff can form spores that can persist in the hospital environment for weeks.

But the lack of antimicrobial stewardship programs, as antibiotic-limiting efforts are called, persists in nearly half of hospitals — despite the fact that the infection control leaders surveyed almost all agree that such efforts have been proven to prevent C. diff infections.

In addition to the lack of antimicrobial stewardship programs, the researchers also found a widespread lack of written policies to test patients for C. diff infection when they developed diarrhea while taking antibiotics or within several months of taking them. Nearly three-quarters of hospitals didn’t have such policies, though diarrhea is a key symptom of C. diff.

“C. diff infection over the last decade has emerged as a threat to patients, especially the most vulnerable and the elderly, and has increased in incidence and severity,” said Sanjay Saint, M.D., MPH, lead author of the new paper.

“There are many ways to try to limit the spread, and from our data it looks like hospitals are aware of the evidence behind them and acting on many where they believe the evidence is strong,” he said. “But the one area where there’s a major disconnect between evidence and practice is antimicrobial stewardship, or limiting antibiotics to use only when necessary. This is a real opportunity for improvement.”