CDI Prevention Protocols Maddeningly Inconsistent

APIC president-elect Jennie Mayfield, an infection preventionist and epidemiologist at Barnes-Jewish Hospital/Washington University Medical School in St. Louis, MO, says that many of the responses were surprising. "But to me, they all reflect the fact that we don't fully understand the epidemiology of this organism. We just have more basic science to do."

She adds that for her, the take-home message is that there remains a "variety of policies and practices regarding when to initiate isolation, and when to stop." Perhaps most discouraging, she says, is that despite hospitals' additional interventions, "rates have not gone down."

There is no national guideline, "because there are no strong published studies that tell us what to do. Evidence-based research [is needed], and we just don't have that for C. difficile."

And there aren't any studies underway that will yield answers anytime soon, she says. "It boils down to money," Mayfield says. "We're aware that the research budgets for federal agencies, including the CDC, have all been cut."

So today, in any healthcare setting, "people are trying to find their own solutions in their individual facilities." According to the APIC survey:

• One-third of respondents said their current policy on cleaning a room occupied by a patient infected with C. diff does not include the use of sodium hydroclorite (bleach) solution.

• Only 21% of respondents said their organizations had added infection prevention staff in the last three years, while 77% said they had not.

• But 9% of the responders said they always use bleach for all room cleaning and 6% use bleach only during outbreaks or increases in infection rates. Another 5% use other routine hospital disinfectants for all room cleaning and disinfection.

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