Many of us think of hospitals as sterile places, kept immaculately clean, free of germs. And certainly, no one goes into the hospital expecting to get even sicker from a bacterial infection. However, hospitals are not kept as clean as they should be, exposing patients to dangerous germs. One such germ, Clostridium difficile (often referred to as C. diff) is a tough, dangerous bacterial infection that easily spreads in hospitals throughout the US. How do patients get C. diff infections? How can hospitals reduce the incidence of infections?
What is C. diff?
C. diff is a bacterial germ that causes diarrhea and colitis (colon inflammation).
- Severe diarrhea.
- Stomach tenderness or pain.
- Loss of appetite.
The frequent bouts of diarrhea can cause dehydration, which can lead to other complications like kidney failure. And, since C. diff is an infection, it can cause sepsis, which can be fatal.
How common and deadly is it?
Based on data from a 2011 study, the Centers for Disease Control and Prevention (CDC) estimates there are over 450,000 cases per year in the US, causing approximately 15,000 deaths.
And it’s a persistent bug. About 1 out of every 6 patients who get C. diff will get it again within 2-8 weeks.
What causes the spread of C. diff?
Simply put, C. diff germs are carried from person to person in poop. And over 94% of C. diff infections occur in hospitals.
When people don’t wash their hands thoroughly with soap after using the toilet, they can leave C. diff germs on any surfaces and people they touch.
If you touch a contaminated surface or person, you can transfer the germs to your mouth and swallow them. Additionally, if healthcare providers touch contaminated surfaces or infected patients, they can spread the infection to you if they don’t thoroughly wash their hands before touching you.
The good news is that healthy people often do not get sick, even if the germs reach their intestines. However, if your immune system is weakened or you’ve recently taken antibiotics, you could get sick.
Unfortunately, C. diff can live for months, or even years, on a range of surfaces, including door knobs and bed rails, and can only be killed with a strong germ-killing agent, like bleach. And as gross as it sounds, C. diff can live on your skin.
Who can develop an infection?
Although C. diff can infect anyone, most cases occur while you are taking antibiotics or soon after you’ve finished taking antibiotics.
However, other factors increase your risk, including:
- Being 65 or older.
- A recent stay at a hospital or nursing home.
- A weakened immune system, which can occur as a result of HIV/AIDS, cancer, or by taking immunosuppressive drugs.
- Previous infection with C. diff or known exposure to the germs.
Does C. diff go away on its own?
Generally, a person with symptoms from a C. diff infection often requires treatment.
The first step usually involves stopping the antibiotics thought be causing the infection. In mild cases, this might be the only treatment needed.
Although antibiotics often cause these infections, doctors use two very powerful antibiotics – Flagyl and Vanocin – to kill the C. diff bacteria.
However, sometimes C. diff cases don’t respond to either of these antibiotics, leading to infections that persist for months or years. Fortunately, a new treatment, involving the transplant of “healthy” donor poop, has successfully cured 90% of patients’ recurrent C. diff infections.
In rare cases, serious infections can lead to surgery to remove a damaged section of the bowel.
How can hospitals and other facilities control C. diff infections?
Fortunately, there are steps that hospitals and other in-patient facilities can take to prevent infections from occurring, and to reduce the spread of infections.
- Doctors and nurses should clean their hands after caring for every patient.
- Hospital rooms and medical equipment should be thoroughly cleaned often.
- When patients develop a C. diff infection, hospitals should separate from other patients, and require providers and visitors to wear gloves and gowns around these patients.
Additionally, the CDC (Center for Disease Control and Prevention) provides detailed recommendations for the prevention of C. diff cases as well as how to manage infected patients in acute care settings. Their guidelines include recommendations for hand hygiene and room cleaning, isolation of patients with known or suspected cases, developing an infrastructure to focus on these infections, and avoiding antibiotic overuse.
Reducing antibiotic overuse in hospitals.
Importantly, the biggest risk factor for C. diff infections is antibiotic misuse, a common problem in US hospitals. For instance, studies show that 30 – 50% of antibiotics prescribed in hospitals are unnecessary or incorrect.
To reduce the incidence of infections, hospitals must adopt programs to reduce the unnecessary use of antibiotics.
Fortunately, the government strongly encourages hospitals to better control antibiotic use. For instance, as of September, 2019, the Centers for Medicare and Medicaid Services (CMS) requires all US hospitals that receive payments from CMS to develop and implement antibiotic stewardship programs (ASPs).
This requirement means that hospitals must follow nationally recognized guidelines on infection prevention and control programs and ASPs in order to receive Medicare and Medicaid reimbursement.
The number of ASPs is growing, but there is still room for improvement. In a 2017 National Healthcare Safety Network survey, 76.4% of acute care hospitals said they had met all seven of the CDC’s core antibiotic stewardship elements—nearly doubling the number reported in 2014.
But many hospitals in the US, particularly small, rural hospitals, still don’t have antibiotic stewardship programs.
Proper hand hygiene is critical.
To prevent the spread of the germ, proper hand hygiene among medical staff must be practiced. As hard as it is to believe, many doctors and other staff members are not washing their hands regularly.
One study found a median compliance rate of only 40% among medical staff. Interestingly, the researchers found that compliance rates were lower in intensive care units (30-40%), as compared to other settings (50-60%). Additionally, doctors were less likely to wash their hands (32%), as compared to nurses (48%).
Similarly, a 2014 study found that less than 1/3 of healthcare workers in an intensive care unit always washed their hands.
Why aren’t medical providers washing their hands frequently enough? It’s likely a combination of forgetfulness, time-related pressures, exhaustion, skin irritations, and apathy.
Proper cleaning is key.
Since C. diff is a hardy species that can survive for weeks on a range of surfaces, rooms in hospitals and other facilities must be cleaned with stringent, EPA-approved cleaners that contain germ-killing agents (such as bleach) every time an infected patient passes through.
How well does your hospital reduce the risk of C. diff infections?
Although C. diff rates vary among hospitals, many are not doing a good job, including some major teaching hospitals.
You can look up C. diff infection rates on either of these sites:
Medicare’s Care Compare website – you can search by name, facility type, or location. After you select the facility you want to review, click on the “Complications and Death” tab. Scroll down to the “Infections” section to find the rate of C. diff infections. The number given is a standardized infection ratio (SIR), which compares the actual number of infections at a hospital to a national benchmark based on data reported to the National Healthcare Safety Network (NHSN).
The Leapfrog Group – on this nonprofit organization’s website, you can search by hospital name or location. After you select the hospital you want to review, click on the “Healthcare Associated Infections” tab, then scroll down to find information on the SIR C. diff infection rates.
You can also find information on how well the hospital manages handwashing protocols under the “Preventing and Responding to Patient Harm” tab. And you can visit their Leapfrog Hospital Safety Grade site for a hospital’s overall safety grade, along with safety related grades for specific factors, including infections, problems with surgery, and safety problems.
How can you reduce your risk of a dangerous C. diff infection?
- Ask your hospital, or nursing home, before admission if possible, what programs they have in place to reduce C. diff infections.
- Are they checking stool samples of all patients with diarrhea?
- What are their cleaning protocols?
- What hand hygiene protocols to they follow?
- Are C. diff patients kept in single rooms?
- Bring your own bleach-containing wipes and clean all surfaces the patient will touch, including the bed rails, doorknobs, tray tables, faucet handles, etc. Do this throughout your stay, as medical staff can easily carry the infection from one room/patient to another.
- Ask all medical professionals to wash their hands with soap and water and put on gloves if you don’t personally see them do so. If they say they washed their hands in the hall before entering, ask them to do it again. It’s possible for germs to live on doorknobs, so doctors should wash their hands after entering the room. Importantly, alcohol-based hand sanitizers will not kill C. diff; you must wash hands for 40-60 seconds with soap. Do not be shy about asking – your life may depend on it!
- If you have had previous C. diff infections, make sure all your doctors know your history.
- Before taking antibiotics, ask your doctor if you really need them. And if you need them, take them exactly as prescribed – do not stop taking them without your doctor’s permission.
- Before taking heartburn reducing medications, ask your doctor if you need the medication or if the doctor is prescribing them as a precaution. These medications can increase your risk of getting a C. diff infection.
For more information on hospital infections and germs, read these posts:
- How to Protect Yourself from Hospital Infections.
- Germs in Hospitals and Doctor Offices – Watch Out!
- What’s Your Hospital’s Safety Record? Is Your Hospital Safe?
- Is Your Hospital Safe? Are Programs in Place to Avoid Dangerous “Never Events”?
- Handwashing in Healthcare Could Save Your Life!
- Why is Sepsis so Dangerous?
- Protect Yourself from Superbugs.