Infectious Diarrhea on the Rise in U.S. Healthcare Settings

With rates and deaths associated with Clostridium difficile (C. difficile), a pathogen that can cause diarrhea, at a historically high level, the Society for Healthcare Epidemiology of America (SHEA) recommends increasing prevention efforts aimed at controlling the spread of C. difficileincluding good hand hygiene and antimicrobial stewardship.  Unnecessary antibiotic use can create an environment for C. difficile to grow and create serious health issues. To help eliminate inappropriate use of these drugs, antimicrobial stewardship programs and interventions help guide prescribers understanding of when antibiotics are needed and what the best treatment choices are for a particular patient.

Nearly 50 percent of antibiotics are inappropriately prescribed, killing off the natural protective bacteria in our gut, says Jan E. Patterson, MD, MS, president of SHEA. The increased prevalence in C. difficile demonstrates the need for better control and use of antibiotics, not only to preserve the efficacy of these life saving drugs, but to prevent adverse events like C. difficile infection.

C. difficile can spread from person-to-person on contaminated equipment and on the hands of healthcare professionals and visitors. But C. difficile infections can be prevented. In the Compendium of Strategies to Prevent Healthcare-Associated Infections, SHEA recommends that health professionals clean hands with soap and water during outbreaks to prevent transmission of C. difficile infections. Evidence shows that soap and water is superior to alcohol-based sanitizers for removing C. difficile spores. Healthcare professionals should also follow contact precautions and wear gloves when entering the room of a patient with C. difficile. 

CDCs Vital Signs report found 337,000 cases of C. difficile occur annually in the U.S. and are linked with about 14,000 deaths, adding at least $1 billion in healthcare costs. In its report, CDC used data collected from the National Healthcare Safety Network (NHSN), a surveillance system that helps monitor healthcare associated infections (HAIs) and adverse events in health settings throughout the U.S.  In recent years CDCs budget for NHSN has flat lined and faces severe cuts and greater demands for increased surveillance, often times written into state legislation on infection prevention.

With an increasing need to monitor existing and emerging biological threats, the need for CDC to collect and analyze HAI data is necessary not only for public health, but national security, says Patterson. With these cuts, the nations ability to identify and track infections is severely challenged. 

CDCs Vital Signs report also found early prevention projects in Illinois, Massachusetts and New York have been showing declines in hospital C. difficile rates. Key factors in these success stories have included a multi-disciplinary team approach, support from hospital administration and a focus on strict adherence to infection control.

Patterson notes, it is important to create a public dialogue about infections such as C. difficile what they are, where they are most likely to occur and how they spread. This is a critical component of increasing our understanding of these infections and ultimately reducing rates of them.