Study: Intestinal Infection Afflicts 13 of 1,000 Hospital Patients

ORLANDO, Fla. – The life-threatening bacterium that causes diarrhea
and more serious intestinal conditions, Clostridium difficile, is sickening many more
patients than previously estimated, according to a new study released today by the
Association for Professionals in Infection Control and Epidemiology (APIC).

“The National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities”indicates that 13 out of every 1,000 inpatients were either infected or colonized with C.difficile. Based on this rate, it is estimated that there are at least 7,178 inpatients on anyone given day in American healthcare institutions with an associated cost of $17.6 to$51.5 million. The rate is 6.5 to 20 times greater than previous incidence estimates,according to the survey, released at APIC’s conference, “Clostridium difficile: A Call toAction,” in Orlando, Florida.

The APIC survey, the largest, most comprehensive of its kind, presents a one-daysnapshot in time of the prevalence of C. difficile infection (CDI) in American hospitals.

APIC’s 12,000 members collected data about all of their CDI patients on one daybetween May and August 2008. Survey results were collected from 12.5% of all medicalfacilities in the U.S. that care for virtually every type of patient, including those at acutecare, cancer, cardiac, children’s, long-term care and rehabilitation hospitals. A total of1,443 patients were identified with CDI from among the 648 participating hospitals.

CDI is most frequently associated with previous antibiotic use and is most commonlycontracted by the elderly and those with recent exposure to hospitals, nursing homesand other healthcare institutions. It is transmitted by hand contact with itemscontaminated by feces. In the last five years, a more virulent and antibiotic-resistantstrain has developed which has been associated with more serious disease, treatmentfailures and deaths.

“This study shows that C. difficile infection is an escalating issue in our nation’shealthcare facilities,” said William Jarvis, MD, principal investigator of the study andpresident and co-founder of Jason and Jarvis Associates, a private consulting firm inhealthcare epidemiology. ” Clearly, preventing the development and transmission of CDIshould be a top priority for every healthcare institution.”

According to the survey, 54.4 percent of patients with CDI were identified within 48 hoursof admission and 84.7 percent were on the medical services, meaning they were beingtreated for general medical conditions like diabetes, pulmonary or cardiac problems andwere on wards throughout the hospital.

“Our results show that the majority of CDI patients are admitted to the hospital alreadyinfected,” said APIC 2008 President Janet E. Frain, RN, CIC, CPHQ, CPHRM, Director,Integrated Services, Sutter Medical Center in Sacramento, CA. “Hospitals need to belooking for patients with severe diarrhea, and if CDI is suspected, promptly instituteappropriate precautions such as gloves, gowns and separating patients, to avoidspreading the infection. Early recognition of CDI is critical so that prevention measurescan be implemented.”

To reduce the risk of transmission, APIC has published a “Guide to the Elimination ofClostridium difficile in Healthcare Settings.” APIC recommendations include a riskassessment to identify high-risk areas for CDI within the institution; surveillanceprogram to outline activities and procedures to provide early identification of CDI cases;adherence to CDC hand hygiene guidelines; use of contact precautions (e.g., gloves,gowns and separating CDI patients from other patients); environmental andequipment cleaning and decontamination, especially items that are close to patientssuch as bedrails and bedside equipment; and antimicrobial stewardship programswith focus on restriction of antibiotics associated with CDI and unnecessary antimicrobialuse. APIC’s evidence-based elimination guides translate CDC recommendations intopractice.

“Healthcare providers must intensify efforts toward developing prevention strategies thatcan be consistently applied across the continuum of care,” said APIC CEO Kathy L.Warye. “Control of CDI requires adequate numbers of infection preventionists andenvironmental services personnel, and prevention practices need to be part ofeveryone’s job within the institution. As part of our Targeting Zero initiative, APIC willcontinue to call for the commitment of clinical and administrative leadership to providingadequate resources for infection prevention programs to better protect patients in ournation’s healthcare facilities.”

The APIC National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilitieswill be published in the American Journal of Infection Control.

For more information about the study, visit

APIC November 2008 press release.

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