Cleaning Up C. Diff, Together
This article appears in the March 2012 issue of HealthLeaders magazine.
Of the long list of contagious infections quality leaders deal with, Clostridium difficile is perhaps the most troublesome. And as if the original infection wasn't bad enough, many hospitals are starting to see NAP1 and other hyper-virulent strains. But in the face of this increasingly resistant adversary, some organizations are forming interdisciplinary task forces and successfully decreasing C. diff incidence by changing the way staff cleans and administers antibiotics.
In 2004 at Hunterdon Medical Center in Flemington, NJ, quality leaders started noticing that C. diff patients were presenting differently and had stronger symptoms than previous C. diff patients. They also saw more cases—the number of C. diff infections more than doubled between 2002 and 2006.
"It used to be common if people [with C. diff] stopped antibiotics they'd get better and didn't require treatment, but these folks really needed treatment and we were seeing readmission with reoccurrence and people with much more time spent in the hospital," says Kathy Roye-Horn, RN, CIC, director of infection prevention at Hunterdon, a 145-staffed-bed nonprofit community hospital. "We could see the disease had changed."
It was in fact the NAP1 strain, which emerged around the year 2000 and makes patients that it infects sicker and is more likely to cause illness when it becomes colonized in a patient.
"In the case of NAP1, not only does it produce more toxin plus an additional toxin, it is also highly resistant to fluoroquinolone antibiotics that began to be more widely used in older patients in the late 1990s," according to L. Clifford McDonald, MD, senior advisor for science and integrity for the division of healthcare quality promotion at the CDC. "This provided an important selective advantage to NAP1, promoting its spread across North America and Europe—further emphasizing this is a public health problem as much as a healthcare quality problem, and both viewpoints must be employed to control this."
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