Another factor that may contribute to the spread of C-diff in hospitals is the widespread use of alcohol hand gels as a part of hand hygiene programs. These hand gels do kill bacteria, but they do not kill the C-diff spores, thereby allowing the spores to be transferred between patients. Only hand-washing with soap and water will kill the spores.
Both the JCAHO and CMS are taking notice of the rising incidence of C-diff. Hospital acquired C. difficile infection is one of the nine new proposed "never events" for which Medicare will no longer pay at a higher rate if it is acquired during a hospital stay. JCAHO's 2009 National Patient Safety Goals require hospitals to "implement evidence-based practices to prevent healthcare associated infections due to multiple drug resistant organisms in acute care hospitals. 5" This goal applies to Clostridium difficile, among other infections. The requirement has a one year phase-in period. Details of the requirements are available on the Joint Commission web site:
So what can hospitals do to combat C. difficile?
The treatment and control of C-diff must be an organizational priority and involve a multidisciplinary approach.
Gather data about the incidence of C-diff in their institution. This should include testing not only for the toxin, but also for the specific organism, so that the strain of C-diff is identified. It is likely that the states or the CDC will require reporting in the future.
Prepare for JCAHO and CMS. Hospitals should assess patients for C. difficile at admission and throughout their stay. Strict infection control practices, and other measures recommended by the CDC, JCAHO, and other organizations will also need to be implemented.
Review your institution's hand hygiene procedures and implement a multifaceted approach to treatment and control. Be sure that adequate hand-washing facilities exist. Enforce the need for hand-washing procedures, rather than reliance on alcohol gels for all patients with C-diff, institute barrier precautions, as needed, and pay very close attention to environmental cleaning.
Hospitals should carefully review the use of prophylactic pre-operative antibiotics to prevent surgical wound infections, especially in the elderly. The benefits will need to be balanced against the risks a C. difficile infection.
Prepare for JCAHO and CMS. Hospitals should assess patients for C. difficile at admission and throughout their stay. Strict infection control practices, and other measures recommended by the CDC, JCAHO, and other organizations will also need to be implemented.
Review your institution's hand hygiene procedures and implement a multifaceted approach to treatment and control. Be sure that adequate hand-washing facilities exist. Enforce the need for hand-washing procedures, rather than reliance on alcohol gels for all patients with C-diff, institute barrier precautions, as needed, and pay very close attention to environmental cleaning.
Hospitals should carefully review the use of prophylactic pre-operative antibiotics to prevent surgical wound infections, especially in the elderly. The benefits will need to be balanced against the risks a C. difficile infection.