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CDI: Making the Case for Better Prevention Efforts

Clostridium difficile infection (CDI) is a common and sometimes fatal healthcare–associated infection. It manifests as diarrhea that often recurs and can progress to toxic megacolon, sepsis, and death. “The incidence, mor­tality, and healthcare costs resulting from CDIs in hospitalized patients have reached historic highs,” says L. Clifford McDonald, MD, FACP, FSHEA. “CDI often occurs in patients in healthcare settings where antibiotics are prescribed and symp­tomatic patients are concentrated.” From 2000 to 2009, the number of hospitalized patients with any CDI discharge diagnoses more than doubled; the number with a primary CDI diagnosis more than tripled. “While the incidence of other healthcare-associated infections has declined, the incidence of CDI has increased,” Dr. McDonald says. Evidence-based guidelines are available for preventing CDI in hospitals, but the degree to which adherence to these guidelines can effectively help prevent these infections is unknown. Analyzing the Impact of CDI In the March 13, 2012 Morbidity & Mortality Weekly Report, Dr. McDonald and colleagues published a study that sought to identify healthcare exposures for CDI, determine the pro­portion of CDI occurring outside hospital settings, and assess whether prevention programs can effectively reduce CDI. The research team analyzed population-based data from the Emerging Infections Program as well as present-on-admission and hospital-onset, laboratory-identified CDI events that were reported to the National Healthcare Safety Network (NHSN). When analyzing data from the Emerging Infec­tions Program, 10,342 CDIs were identified. “Overall, 94% of all CDIs were related to various precedent and concurrent healthcare exposures,” says Dr. McDonald. “About three-fourths of CDIs had their onset occur outside of hospitals [Figure 1]. It should also be noted that some cases occurred in...

The Framework for Eliminating HAIs

Healthcare-associated infections (HAIs) are one of the leading causes of death in the United States and are becoming increasingly problematic for hospitals and healthcare facilities throughout the country. The World Health Organization has reported that approximately 1.4 million people have an HAI at any given time. Compounding the problem is that little is known about the burden of infections outside of hospitals, particularly in long-term care facilities, ambulatory surgical centers, and other outpatient settings. The emergence of HAIs caused by multidrug-resistant microorganisms is another increasing concern. As Americans continue to age and healthcare costs continue to rise, the elimination of HAIs is paramount for improving patient health and healthcare savings. “The number of people who become sick or die from HAIs is unacceptably high, and these infections cause a significant financial burden,” says Denise Cardo, MD. “As consumers are increasingly asking for transparency and accountability in healthcare, their expectations on how well these infections are managed will continue to increase. This is a unique and timely opportunity to move toward the elimination of these infections.” Inconsistent Implementation According to Dr. Cardo, tried and true preventive measures for HAIs are inconsistently implemented. “The success of prevention efforts has varied considerably from one setting to the next,” she says. “However, we have a growing body of knowledge that defines a full range of prevention interventions that can address specific HAIs when consistently applied across settings. HAIs can be eliminated by implementing a proven framework for prevention at all levels of healthcare delivery. For the infections that we know how to prevent, we must prevent them consistently and effectively. For the infections...
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