Daily Editors' Notes

September 11 death count, times 10

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John O'Connor, editorial director, McKnight's Long-Term Care News
John O'Connor, editorial director, McKnight's Long-Term Care News
Many people shudder when they think about the 9/11 tragedy, and rightfully so. The four suicide attacks carried out on September 11 of 2001 caused nearly 3,000 deaths.

But imagine if there were 10 such attacks every year and 30,000 people died. Actually, 30,000 people do die every year, thanks to a silent killer most people have never heard of: Clostridium difficile.

C. diff is a species of bacteria that causes severe diarrhea and other intestinal disease. It has emerged as the most persistent cause of infections plaguing skilled nursing facilities and other healthcare settings, according to a recent report by USA Today.

The paper's investigation reveals that C. diff is far more prevalent than federal reports previously indicated. The bacteria are linked to more than 30,000 deaths a year in the United States — about twice federal estimates. It strikes about a half-million Americans a year.

But despite a decade-long rise in C. diff rates, providers have been slow to adopt proven strategies that can reduce the infections. If anything, many operators are cutting back on housekeeping and other services that might be helpful.

Cutting C. diff rates is hardly a mystery. C. diff spores spread via fecal contamination: The spores get on people's hands and move to other surfaces by touch. The tough-to-kill spores resist many disinfectants and can survive for months. Once they're on patients' hands, it's a short trip to their mouths.

The challenge is twofold: Control the use of antibiotics that allow C. diff to flourish, and prevent the bacteria's spread from infected patients via dirty hands, dirty rooms or dirty equipment.

Prevention strategies include discontinuing any suspected antibiotic. Providers should also follow these additional steps:

  • Meticulous and proper hand hygiene for healthcare workers, patients and visitors;
  • Utilizing soap and water and avoiding alcohol-based rubs that are not sporicidal;
  • Environmental cleaning with sporicidal cleaning agents;
  • Placing patients under contact isolation infection control procedures until resolution of the diarrhea; and
  • Adopting antibiotic restriction policies to limit excessive antimicrobial use.

General management strategies include:

  • Discontinuing all unnecessary antimicrobials or utilizing lower-risk agents when able;
  • Monitoring volume status and electrolytes and appropriately replete when necessary;
  • Avoiding anti-diarrheal agents, such as loperamide, atropine, or diphenoxylate, as these agents do not allow the toxin to be excreted and can worsen symptoms and lead to serious complications;
  • Encouraging patient hand hygiene through use of soap and water;
  • Possibly avoiding the use of lactose-containing foods;
  • Possibly discontinuing proton pump inhibitors and other acid suppressants; and
  • Administering specific anti-Clostridial antibiotics, if necessary, based on infection severity.

Experts say that U.S. officials could get a better handle on C. diff by requiring nursing homes to report infections and antibiotic usage rates. This requirement – while burdensome – has helped healthcare facilities in the United Kingdom reduce C. diff rates.

The British experience shows that reductions are possible, according to Don Goldmann, senior vice president at the Institute for Healthcare Improvement. "We can do better,” he says, “and we really need to."

He's got that right.

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Daily Editors' Notes

McKnight's Daily Editor's Notes features commentary on the latest in long-term care news. Entries are written by Editorial Director John O'Connor on Monday and Friday; Staff Writer Tim Mullaney on Tuesday, Editor James M. Berklan on Wednesday and Senior Editor Elizabeth Newman on Thursday.

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