Pennsylvania Patient Safety Authority data shows almost 40 percent of gastrointestinal infections in nursing home patients are CDI related and bloodstream infection risk reduction strategies in PA health facilities are questioned
Clostridium difficile infections (CDIs) are quickly becoming a significant issue in healthcare based upon recent studies. Preliminary data collected from nursing homes and highlighted in a Supplementary Pennsylvania Patient Safety Advisory shows that almost 40 percent of gastrointestinal infections reported are CDIs.
"Our first look at infection data submitted from Pennsylvania nursing homes confirms what prior studies have found in hospitals -- C. diff infections are a real problem in healthcare institutions," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Elderly patients are particularly at risk because of their age and their use of hospitals and nursing homes where the infection can spread more easily."
The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project showed that from 1993 to 2001 hospital discharges with CDI increased by 74 percent (from 85,700 patients annually to 148,900). CDI cases nearly doubled from 2001 to 2005 with a 102 percent increase in patients discharged with CDI (from 148,900 to 301,200).
Clostridium difficile infection is caused by a spore-producing bacterium in the Clostridia family. It is the most common cause of healthcare-associated infectious diarrhea in healthcare facilities. The elderly or people receiving antibiotics are more likely to develop a CDI. Many people may not realize they have C. difficile until it is too late.
"The elderly or people taking antibiotics are at an increased risk for developing CDI," Doering said. "C. difficile can develop because of the antibiotics. Unfortunately, for some, they do not realize the diarrhea they are experiencing can be much more serious than a case of food poisoning or brief illness.
"Patients can die from these complications if they are not treated right away," Doering added.
Doering said data from the Pennsylvania Healthcare Cost Containment Council (PHC4) also shows increases in CDI. Pennsylvania hospitalizations from CDI increased from 7,026 cases in 1995 to 20,941 cases in 2005. The hospitalization rate for CDI increased 173 percent from 1995 to 2005.
"Education is the key for fighting these infections," Doering said. "Healthcare facilities and nursing homes need to implement infection prevention strategies and educate all staff, including housekeeping personnel, about effective C. diff prevention strategies that have been proven to work.
"Patients must also be properly educated about C. difficile when discharged, so they know what to expect at home," Doering added.
The Authority began collecting infection data from nursing homes in June 2009. The preliminary data analyzed was collected from nursing homes July 1 through September 30, 2009.
For more information on CDIs, risk reduction strategies and consumer tips go to the 2010 March Supplementary Pennsylvania Patient Safety Advisory article "Clostridium Difficile Infections in Nursing Homes," on the Authority's Web site at www.patientsafetyauthority.org.
Doering said another infection issue highlighted in the 2010 March Supplementary Advisory involves the high risks associated with patients who contract central line-associated bloodstream infections, also known as CLABSI.
A central line or central venous catheter (CVC) is a long hollow tube similar to the intravenous lines placed in a patient's arm, except the CVC is placed into larger veins found in the patient's neck, upper chest, leg or arm. It can remain in place, in some cases for several weeks; therefore if it is not cleansed properly can be prone to infection. Infection can occur when bacteria grow in the line and spread into the bloodstream. These serious, sometimes deadly infections can often be successfully treated with antibiotics. Sometimes the only way to cure the infection is to remove the catheter.
Doering said a March 2008 Centers for Disease Control and Prevention (CDC) report estimates the cost of one CLABSI in 2007 U.S. dollars to be $29,156, which totals $2.68 billion in excess costs annually. In another study, it was found that 98,987 patient deaths caused by or associated with healthcare-associated infections in 2002, 31 percent of those cases were attributed to bloodstream infections.
He added that Pennsylvania hospitals do better than the national average in regard to CLABSIs. The Authority analyzed data from the National Healthcare Safety Network (NHSN), the system hospitals must report all healthcare-associated infections through since Act 52 2007. The Authority analysis (from July 2008 through March 2009) showed that Pennsylvania hospitals calculated average CLABSI rates at 1.8/1000 central line days for critical care areas and 1.1 for ward locations. For patients in Pennsylvania hospitals who are at risk for CLABSI because they have a CVC in place, the rate of infection was better than the national averages of 2.0/1000 central line days for critical areas and 1.4 for ward locations. However, analysis also shows there are some questions concerning the sustainability of such numbers.
"The Authority analysis of data shows that while Pennsylvania's hospitals are doing better than the national average in preventing CLABSIs, in thirty-eight percent of the events reported they are unable to document compliance with evidence-based best practices for CLABSI prevention," Doering said. "The lack of documentation begs the question of whether facilities are doing as much as they can to generate real changes that lead to permanent reductions."
The Authority analysis of the Pennsylvania NHSN CLABSI events found that compliance with evidence-based best practices averaged 55.8 percent for the 1,916 CLABSI reports. However, 38 percent of the CLABSI reports documented unknown compliance with these basic best practices, and 4.4 percent of the remaining responses indicated that the best practices were not used.
These evidence-based practices include: using full sterile barriers to prevent infections, using the right product (chlorhexidine) to prepare the site in which the CVC will be inserted, and daily reviewing and documenting whether or not the patient should continue to have the CVC in place.
Analysis also shows that hospitals with the lowest CLABSI rates reported a significantly higher rate of compliance with daily evaluation and documentation of central line necessity and use of all three practices twice as often as hospitals with the highest rates of infection.
"The key to real success in preventing these types of infections is to ensure the process you have in place to prevent them is the best it can be and followed religiously by all staff involved," Doering said. "Many Pennsylvania hospitals are doing a good job in preventing these infections, but continued changes and vigilance are required to eliminate them once and for all."
Doering added that consumer tips are also available for patients on what they can do to protect themselves from CLABSI.
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