Amid the growing prevalence of multidrug-resistant organisms, hospitals must implement thorough prevention methods to reduce healthcare-associated infections and protect their bottom line.
U.S. acute care hospitals reported an estimated 722,000 HAIs in 2011, according to the 2014 HAI Prevalence Survey. Of 183 hospitals surveyed nationwide, Clostridium difficile was the most commonly reported pathogen, accounting for 12.1 percent of all HAIs.
This article is sponsored by EcoLab.
"C. diff is very prevalent in today's healthcare environments," said Linda Homan, BSN, CIC, senior manager of clinical and professional services at St. Paul, Minn.-based Ecolab, a provider of water, hygiene and energy technologies and services. "Patients are constantly moving between acute and long-term care, which is helping proliferate the spread."
The high mortality rate and risk of recurrence associated with C. diff infections make them both difficult and expensive to treat. Researchers estimated 83,000 patients who develop the infection experience at least one recurrence, and 29,000 die within 30 days of diagnosis, according to 2015 research published in the New England Journal of Medicine. CMS requires hospitals to cover the cost of treating these infections under its Hospital Acquired Condition payment provision, which comes directly out of a hospital's bottom line.
"In the current healthcare climate, you have to not only look at your reimbursables, but also your rating on Hospital Compare and Leapfrog," says Mary Scott, BSN, RN, an infection preventionist at Beaufort (S.C.) Memorial Hospital. HAIs are now publicly reported, and a high infection rate can tarnish a hospital's reputation.
As C. diff holds serious consequences for both patient outcomes and hospitals' financial health, it's crucial healthcare facilities develop targeted prevention methods to reduce infection rates.
What is fueling C. diff infections?
C. diff is a very hearty, spore-forming bacteria transmitted via the fecal-oral route. Infections often originate when antibiotics are administered to patients, altering their normal gut bacteria and allowing C. diff to proliferate.
Regular use of broad-spectrum antibiotics is a common practice that poses an infection risk to patients. More than half of all inpatients will receive an antibiotic during their hospital stay, and up to 50 percent of antibiotics prescribed in hospitals are unnecessary or incorrect, according to the CDC. Studies have linked overuse of antibiotics to more resistant forms of HAIs, including C. diff. When patients are prescribed broad-spectrum antibiotics in the hospital, the medication kills infection-causing bacteria, as well as good types of bacteria in the gut. This often weakens patients' immunity, making them vulnerable to contracting drug-resistant C. diff in the hospital setting.
Once a patient contracts C. diff, the individual sheds spores into the environment, which can survive on surfaces for up to five months, according to Ms. Homan.
"Patients are often shedding these spores the whole time they're in the hospital," she says. "There are now studies showing patients shed C. diff after they cease to show symptoms of infection."
Infection prevention guidelines recommend hospitals use an Environmental Protection Agency-registered sporicidal disinfectant on all surfaces and equipment in rooms housing patients with a C. diff infection. If a hospital's environmental services staff does not use the proper cleaning products and follow recommended processes in these isolation rooms, C. diff spores may be left on surfaces in the room. The cleaning process is further complicated by patients who do not show symptoms of infection — and are therefore not kept in isolation rooms — who may still be shedding spores, according to Ms. Homan. If the EVS staff is not aware these patients are infected, they may not clean the room with the appropriate disinfectants needed to kill C. diff. When spores are left in a patient room after cleaning, the next patient to stay in the room is at risk of exposure, which may cause additional infections.
In addition, healthcare workers' hands can become contaminated with C. diff, which can then be passed on to the next patients they care for. Most recommended best practices cite soap and water and the friction of hand washing as the most effective way to remove C. diff from healthcare workers' hands, instead of alcohol-based hand sanitizers.
How hospitals can reduce C. diff infections
Hospitals can adopt numerous practices to effectively kill C. diff in healthcare environments and prevent infections. Ensuring infection prevention personnel eliminate environmental C. diff contamination during the disinfecting process is crucial to reducing HAI rates.
"Hand hygiene and environmental hygiene are both really important because there is a continuous transmission of pathogens between the patient, environment and hands of the healthcare worker," says Ms. Homan.
Because healthcare workers' hands are constantly in contact with environmental surfaces, hand and environmental hygiene go arm in arm. To break the cycle of contamination, hospitals must also practice good environmental hygiene to ensure C. diff spores are not left on surfaces or equipment in patient care environments.
Spores are very hard to kill with commonly used disinfectants. Instead, hospitals must use a sporicidal disinfectant or bleach to remove C. diff from hospital surfaces. While bleach effectively kills C. diff, regular use can harm the healthcare environment.
"Bleach was damaging our equipment, [destroying] our furniture and leaving a film on surfaces," says Ms. Scott. "We were looking for an alternative to make it easier on the EVS staff."
Beaufort Memorial Hospital began using OxyCide™ Daily Disinfectant Cleaner three years ago, according to Ms. Scott. OxyCide is an EPA-registered one-step cleaner and sporicidal disinfectant made of peracetic acid — which breaks down the outer membrane of C. diff spores — and hydrogen peroxide, which destroys the spores' DNA and proteins. The chemistry of OxyCide provides favorable material compatibility that helps minimize surface damage and does not leave residual films or salts behind. OxyCide does not require personal protective equipment once diluted for use, meaning no additional tools are required for staff safety compliance above and beyond those normally used per facility standard precautions.
Prior to switching to OxyCide, Beaufort Memorial used one disinfectant for its regular patient rooms and bleach for its isolation rooms. Now, the 197-bed hospital uses OxyCide in every patient room, since the disinfectant is effective against a broad range of healthcare-associated pathogens.
"It makes [infection prevention] a no-brainer for our EVS staff," she says. "We don't have to worry about communicating with EVS about which products to use in which rooms."
Simplification of the cleaning and disinfection process through the use of OxyCide was not the only process improvement made for the EVS staff. Ecolab also worked with Beaufort Memorial's EVS staff to ensure all employees were trained on environmental hygiene best practices and protocols and consistently cleaning the right areas of patient rooms the correct way.
"You could have the best product in the world, but if you're not cleaning correctly, outcomes won't be optimized," says Ms. Homan. "You need the right product, used with the right processes, and you need tools to monitor practice of these processes to ensure they are performed consistently." She recommends hospitals regularly monitor EVS performance using the Ecolab DAZO® Monitoring Program to provide an objective measurement of cleaning thoroughness. Hospitals can then use this information to provide feedback to employees in a nonpunitive way to continuously improve cleaning standards.
Benefits of good environmental hygiene
Ms. Scott says Beaufort Memorial saw immediate improvement in infection rates after implementing OxyCide in combination with objective environmental monitoring through the use of DAZO and the best practice educational program for EVS staff.
When Beaufort Memorial started using OxyCide in 2014, the hospital reported 41 healthcare-associated C. diff infections. In 2015, the hospital only had 28 cases, according to Ms. Scott. The thoroughness of cleaning, as monitored by DAZO, rapidly increased from 81 percent at the start of implementation to 92 percent, remaining greater than 88 percent in the three years following the program's implementation. Beaufort Memorial also achieved greater operational efficiencies by switching to OxyCide. EVS staff reduced discharge room cleaning time by 33 percent to just 27 minutes, creating more opportunity to achieve higher patient throughput.
Along with improved clinical and operational outcomes, OxyCide can also help healthcare facilities achieve significant cost savings.
Ms. Scott says a single C. diff infection costs Beaufort Memorial $28,000 in upfront costs and increases length of stay by seven days. Every day a patient is in the hospital costs money, so preventing infections and limiting length of stay is critical to a hospital's bottom line.
Beaufort Memorial's reduction in C. diff infections resulted in an average non-reimbursed cost savings of approximately $10,000 per month during the first three years of OxyCide implementation, according to Ms. Scott.
"The reduction in C. diff alone is a huge cost savings," she says. "OxyCide is also much safer to use on our equipment and furniture, so we're saving costs there, as well."
Conclusion
C.diff infections can cause serious health complications for patients while threatening a hospital's reputation and bottom line. Healthcare organizations must take proactive measures to prevent these infections through strong antibiotic stewardship, hand hygiene and environmental hygiene efforts, backed by educational programming and consistent monitoring and feedback for EVS staff. Numerous clinical and financial insights prove OxyCide is a highly effective solution for hospitals when used as part of a programmatic approach to improve health outcomes, create operational efficiencies and achieve major cost savings.