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Selected Category: Clostridium difficile

Clostridium difficile It’s Like Seeing a Train Coming…and You Can’t Get Off of the Tracks

Categories: Antimicrobial Resistance, Clostridium difficile

CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

CDC Vital Signs. Learn vital information about stopping C. difficile infections. Read CDC Vital Signs

Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion

Looking back now, it is like a movie playing out in my mind. We were at the 2004 IDSA conference in Boston, and my colleagues from the CDC lab, Dr. Dale Gerding’s laboratory, other scientific collaborators, and I were presenting on a new strain of Clostridium difficile called NAP1. I’m not sure everyone understood the implications. Some realized NAP1 could be big; others felt that C. diff wasn’t that big of a deal. For me, it was like seeing a train coming, and you can’t get off the tracks.

Clostridium difficile infections have been an important part of my career. Upon wrapping up the SARS investigations for CDC in Toronto, I turned my attention to C. difficile, as I sensed there was something going on that needed further investigation. Now, here we are 8 years later, and NAP1, which causes severe infection, is still a major issue in the United States.

Using fecal transplants to treat recurrent Clostridium difficile infections (CDI)

Categories: Antimicrobial Resistance, Clostridium difficile

Clifford McDonald, MD

Clifford McDonald, MD

Author – Clifford McDonald MD
Prevention and Response Branch Chief
CDC’s Division of Healthcare Quality Promotion

Transplanting feces from one human to another may sound repulsive, but for patients suffering from recurrent, debilitating diarrhea caused by Clostridium difficile, a fecal transplant offers a ray of hope. 

It increasingly appears that fecal transplants are effective in treating recurrent CDI. Though we await randomized controlled trials to confirm signs of efficacy, we at CDC are heartened by this potential treatment.  Also, we are encouraged by our rapidly increasing understanding of the human microbiome, a term that refers to the entire population of microorganisms living on or inside us and all the genetic information possessed by these microorganisms. 

In a recent paper in Clinical Infectious Diseases, Dr. Pritish Tosh and I lay out a framework for the importance of a healthy intestinal microbiome to fight off a large and growing number of multidrug-resistant organisms (MDROs).  We believe that the main effect of antibiotics resulting in drug-resistant organisms is “selective pressure on the human microbiome.” When antibiotics wipe out the good bacteria of the microbiome, those bacteria are replaced by organisms that survived the antibiotic treatment, namely MDROs.  Once colonization with resistant organisms has occurred, these bad bugs can multiply and, in some cases, cause untreatable or severe infections.   These infections include colitis from C. difficile, in addition to bloodstream infections, pneumonias and other serious infections caused by MDROs.

Let’s Take an Antibiotic Time Out

Categories: Antibiotic use, Clostridium difficile, Gram negatives, Healthcare-associated infections

Arjun Srinivasan MD

Author - Arjun Srinivasan, MD
CDC – Medical Director, Get Smart for Healthcare Program

Over the past 2 years, I have brought together experts on antibiotic resistance to discuss how CDC can assist in efforts to improve antibiotic use in hospitals and nursing homes. My colleagues have published numerous studies demonstrating that inappropriate antibiotic use in hospitals and nursing homes results in increased resistance, worse patient outcomes, and increased costs.  It is also helping drive the national epidemic of Clostridium difficile infections.  This year, we have watched as deadly new mechanisms of antibiotic resistance were discovered in U.S. hospitals, mechanisms that will undoubtedly challenge our healthcare system and affect patient safety (see NDM-1, VIM). Clearly, we have a serious problem.

Those initial discussions with colleagues resulted in an expansion of CDC’s Get Smart programs, which target antibiotic use in outpatient clinics and pediatrician’s offices, to include a comprehensive program targeting inpatient settings.  This week, CDC launched the Get Smart for Healthcare program aimed reducing inappropriate antibiotic use in hospitals and nursing homes.  The foundation of this program is the concept that everyone plays a role in improving antibiotic use.

CMS Rule: Shining the spotlight on hospital acquired infections – Part 5

Categories: Clostridium difficile, Healthcare-associated infections, MRSA

Lisa McGiffert

Lisa McGiffert

Guest Author — Lisa McGiffert
Director, Consumer’s Union Safe Patient Project

Is your hospital doing a good job protecting patients from developing infections during treatment? For years, patients have been left in the dark about this important indicator of hospital safety even though these infections are associated with nearly 100,000 deaths annually.

Nancy Oliver, of Cincinnati, Ohio, wished she had known more about her hospital’s infection rates. Nancy’s father was expected to make an excellent recovery following heart surgery but ended up developing a MRSA infection in his surgical site. Later he acquired a C-difficile infection, went into septic shock and died. “We miss my Dad every day,” says Oliver who has become an active patient safety advocate.

Next year, consumers across the country finally will be able to start checking their hospital’s infection prevention track record thanks to new regulations adopted as part of the landmark health care reform law.

The regulations build on the successful efforts of patient safety advocates working with Consumers Union over the past seven years to push states to adopt hospital infection reporting laws. Twenty seven states have done so and 19 have issued reports so far that disclose this critical information to the public.

Consumers can already check the Hospital Compare web site to find out how well hospitals follow procedures proven to reduce surgical site infection risks. But soon the public in all 50 states will be able to see whether their hospital’s prevention efforts are working.

The new regulations will make central line associated bloodstream infection rates in intensive care units, including neonatal intensive care units, available on Hospital Compare next year and surgical site infection rates in 2012. That’s a good start but it should be just the beginning.

Patients have a right to know about other hospital-acquired infection rates, including those caused by MRSA and C.difficile, and urinary tract infections. These additional infections are targeted for improvement by a federal healthcare-associated infection action plan. The public should be able to see if the action plan’s prevention targets for these infections are being met.

Armed with infection rate information, consumers will be able to make more informed decisions about where to go for the care they need. And disclosing this information to the public is a powerful motivator for hospitals to improve care and keep patients safe.

For Nancy Oliver and the countless others who have lost loved ones to hospital-acquired infections, making infection rates public is long overdue.

___________
Lisa McGiffert is the Director of Consumers Union’s Safe Patient Project. Follow the campaign on Twitter @CUSafePatient Consumers Union is the nonprofit publisher of Consumer Reports.

Hand Hygiene: First, Do No Harm – Part 1 of 3

Categories: Clostridium difficile, Hand Hygiene, Healthcare-associated infections

Katherine Ellingson, PhD

Katherine Ellingson, PhD

Kate Ellingson, Ph.D.
CDC Epidemiologist
CDC’s Division of Healthcare Quality Promotion

In patient care, the first rule is to do no harm. I believe a huge component of that concept is hand hygiene – ensuring that every patient is touched only by clean hands . Such a simple concept, yet we know that half or fewer of healthcare personnel actually clean their hands when they should. Perhaps it’s too simple, so much so that we dismiss its importance. At the Centers for Disease Control and Prevention (CDC), we get many requests to clarify those procedures and to find out why people don’t follow them.

When should healthcare personnel wash their hands? The answer is simple – before and after direct patient contact and after contact with the immediate patient environment such as bedrails. This includes before putting on and after taking off gloves. Healthcare personnel should also perform hand hygiene after contact with bodily fluids and before aseptic tasks.

What should healthcare personnel use to disinfect their hands? CDC recommends alcohol-based handrub as the primary mode of hand hygiene. However, hands should be washed with soap and water when they are visibly soiled or after healthcare personnel have been in contact with patients with diarrheal illnesses such as Norovirus or C. difficile.

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