Becker's Clinical Quality & Infection Control

20 Executive Briefing Sponsored by: C. Diff Prevention: A Proactive and Programmatic Approach to Reducing Infections A mid the growing prevalence of multidrug-resistant organisms, hospitals must implement thorough prevention methods to reduce healthcare-associated infections and protect their bottom line. U.S. acute care hospitals reported an estimated 722,000 HAIs in 2011, according to the 2014 HAI Prevalence Survey. Of 183 hospitals surveyed nationwide, Clostridium difficile was the most commonly reported pathogen, accounting for 12.1 percent of all HAIs. "C. diff is very prevalent in today's healthcare environments," said Linda Homan, BSN, CIC, senior manager of clinical and professional services at St. Paul, Minn.-based Ecolab, a provider of water, hygiene and energy technologies and services. "Patients are constantly moving between acute and long-term care, which is helping proliferate the spread." The high mortality rate and risk of recurrence associated with C. diff infections make them both difficult and expensive to treat. Researchers estimated 83,000 patients who develop the infection experience at least one recurrence, and 29,000 die within 30 days of diagnosis, according to 2015 research published in the New England Journal of Medicine. CMS requires hospitals to cover the cost of treating these infections under its Hospital Acquired Condition payment provision, which comes directly out of a hospital's bottom line. "In the current healthcare climate, you have to not only look at your reimbursables, but also your rating on Hospital Compare and Leapfrog," says Mary Scott, BSN, RN, an infection preventionist at Beaufort (S.C.) Memorial Hospital. HAIs are now publicly reported, and a high infection rate can tarnish a hospital's reputation. As C. diff holds serious consequences for both patient outcomes and hospitals' financial health, it's crucial healthcare facilities develop targeted prevention methods to reduce infection rates. What is fueling C. diff infections? C. diff is a very hearty, spore-forming bacteria transmitted via the fecal-oral route. Infections often originate when antibiotics are administered to patients, altering their normal gut bacteria and allowing C. diff to proliferate. Regular use of broad-spectrum antibiotics is a common practice that poses an infection risk to patients. More than half of all inpatients will receive an antibiotic during their hospital stay, and up to 50 percent of antibiotics prescribed in hospitals are unnecessary or incorrect, according to the CDC. Studies have linked overuse of antibiotics to more resistant forms of HAIs, including C. diff. When patients are prescribed broad-spectrum antibiotics in the hospital, the medication kills infection-causing bacteria, as well as good types of bacteria in the gut. This often weakens patients' immunity, making them vulnerable to contracting drug-resistant C. diff in the hospital setting. Once a patient contracts C. diff, the individual sheds spores into the environment, which can survive on surfaces for up to five months, according to Ms. Homan. "Patients are often shedding these spores the whole time they're in the hospital," she says. "There are now studies showing patients shed C. diff after they cease to show symptoms of infection." Infection prevention guidelines recommend hospitals use an Environmental Protection Agency-registered sporicidal disinfectant on all surfaces and equipment in rooms housing patients with a C. diff infection. If a hospital's environmental services staff does not use the proper cleaning products and follow recommended processes in these isolation rooms, C. diff spores may be left on surfaces in the room. The cleaning process is further complicated by patients who do not show symptoms of infection — and are therefore not kept in isolation rooms — who may still be shedding spores, according to Ms. Homan. If the EVS staff is not aware these patients are infected, they may not clean the room with the appropriate disinfectants needed to kill C. diff. When spores are left in a patient room after cleaning, the next patient to stay in the room is at risk of exposure, which may cause additional infections. In addition, healthcare workers' hands can become contaminated with C. diff, which can then be passed on to the next patients they care for. Most recommended best practices cite soap and water and the friction of hand washing as the most effective way to remove C. diff from healthcare workers' hands, instead of alcohol-based hand sanitizers. How hospitals can reduce C. diff infections Hospitals can adopt numerous practices to effectively kill C. diff in healthcare environments and prevent infections. Ensuring infection prevention personnel eliminate environmental C. diff contamination during the disinfecting process is crucial to reducing HAI rates. "Hand hygiene and environmental hygiene are both really important because there is a continuous transmission of pathogens between the patient, environment and hands of the healthcare worker," says Ms. Homan. Because healthcare workers' hands are constantly in contact with environmental surfaces, hand and environmental hygiene go arm in arm. To break the cycle of contamination, hospitals

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