C. diff

Statement from Tom Allocco, New York Department of Health:

United Memorial Medical Center has properly reported its cases of Clostridium difficile (C. diff) to the State Health Department. The department has been working with United Memorial on the implementation of proper infection-control measures to help reduce the spread of illness. These include proper hand hygiene (simple, but probably the most important control measure), cleaning and disinfecting portions of the facility, and the separation of those who are infected from other patients. The department’s investigation of the outbreak continues. Once the investigation is finalized, the findings will be available. 

Additionally, the state health department has a public report on "Hospital Acquired Infections" that was released in late 2010 and covers data through 2009.

According to the report, in 2009, UMMC performed 28 colon procedures and of those, two patients contracted infections. That puts UMMC's infection rate at 7.1 (a number adjusted to calculate infections per 100 procedures to enable statewide comparisons). New York's infection rate for colon procedures in 2009 was 4.8.  

UMMC's rate of 7.1 is considered within the range of state average.

Strong Memorial's rate for 2009 was 5.5, also within the state average.

In 2008, UMMC's rate was 6.4, the state average was 4.4 and Strong was 4.8

In 2008, Strong performed 327 procedures and there were 16 infections. The following year, Strong performed 317 procedures and there were 17 infections.

Erie County Medical Center performed 86 colon procedures in 2008 and 98 in 2009 with three reported infections in each year. Numbers also fell within the statistical average at Highland Hospital in Rochester, while Women & Children's Hospital of Buffalo reported no infections, with about 50 procedures for each year. (For some reason, the report called W&C's zero-infection rate "statistically insignificant" and didn't give it a "blue star" on its report card).

For hip replacement surgery, UMMC's infection rate in 2008 was 3.1, and 2.5 in 2009. Both numbers fall within the range of the state average of 1.1. In 2008, UMMC performed 81 procedures with three infections and in 2009, 84 procedures with two infections. For the same procedure, Strong performed 50 operations in 2008 and 60 in 2009 with no infections.

A reporter from Rochester forwarded me this press release put out by Betsy McCaughey a couple of days ago. The message from the former Lt. Governor of New York and founder of the Committee to Reduce Infection Deaths seems particularly relevant and the information worth reading.

Hospital infections kill more Americans each year than AIDS, car accidents and breast cancer combined -- and researchers are searching for solutions. This week, a study of 153 Veterans Affairs hospitals shows that doing a simple swab test to identify and isolate the few patients carrying infection-causing bacteria can save lives. It's called screening, but even more important is cleaning. Studies are rolling in that hospitals need to be cleaner.

In fact, if you're visiting a friend or relative in the hospital, don't bring flowers or candy -- take gloves and a canister of bleach wipes.

Hospitals do an inadequate job of cleaning rooms -- so germs left behind by past patients are lying in wait. Patients are at far greater danger of infection when placed in a hospital room where a previous patient had an infection. Hospitals won't tell you who occupied the room before you.

Alarming research published in the Archives of Internal Medicine (March 28) demonstrates that a patient's risk of picking up the drug-resistant bug MRSA (methicillin-resistant Staphylococcus aureus) is much higher if the previous occupant of the hospital room had it.

Being placed in a room where the last patient had Clostridium difficile, or C. diff for short, more than doubles the risk of getting that dreaded infection, according to a new study in Infection Control and Hospital Epidemiology (March 2011). C. diff is the most common hospital infection in some parts of America.

Patients pick up invisible C. diff bacteria when they touch surfaces in their room, then eat a roll or cookie with their contaminated hands and swallow the bacteria along with the food.

C. diff causes life-threatening diarrhea -- wreaking havoc in your gastrointestinal system unless you have enough powerful "good" bacteria in your system to keep the C. diff under control. But patients on antibiotics often lack good bacteria. Some hospitals are treating desperately ill patients by giving them fecal enemas.

Pretty awful. Especially when it could be avoided by keeping the patient's room clean.

Dr. Robert Orenstein launched a cleanup campaign at the Mayo Clinic in Rochester, Minn. -- wiping the frequently touched surfaces around each patient's bed once a day with bleach-soaked wipes. The results: a 75- percent drop in C. diff infections.

Lax room-cleaning raises the risk of contracting other kinds of hospital infections, too. The No. 1 predictor of which patient picks up a drug-resistant bug called VRE (vancomycin-resistant Enterococcus) is who occupied the patient's room in the prior two weeks, according to Tufts University investigators. That two-week span could mean three or four patients ago.

A study of 36 hospitals from Boston to Washington, D.C., found that cleaners routinely overlook half the surfaces in patients' rooms. Toilet seats are cleaner than telephones and call buttons.

Doctors and nurses may clean their hands coming into the room -- but recontaminate them when they open the privacy curtain or rest their hands on the bedrail. Then they touch their patient, and germs enter the patient's body via an IV, urinary-tract catheter, wound or surgical incision.

For decades, hospital administrators and government agencies have shrugged off the notion that hospitals are dirty, saying, "germs are everywhere." They emphasize getting doctors and nurses to clean their hands -- which isn't enough.

The Joint Commission, which is responsible for accrediting most hospitals, just considers whether a hospital looks clean -- when infection-causing germs are invisible.

Food-processing plants routinely test surfaces for bacteria. Hospitals ought to meet at least the same standard.

www.HospitalInfection.org