New expert guidelines aim to focus hospitals' infectious diarrhea prevention efforts

(Press-News.org) CHICAGO (May 6, 2014) – With rates of Clostridium difficile (C. difficile) now rivaling drug-resistant Methicillin-resistant Staphylococcus aureus (MRSA) as the most common bacteria to cause healthcare-associated infections, new expert guidance encourages healthcare institutions to implement and prioritize prevention efforts for this infectious diarrhea. The guidelines are published in the June issue of Infection Control and Hospital Epidemiology.

The new practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission.

"The Compendium uses a data-driven approach to focus efforts on strategies most likely to be effective," said Erik Dubberke, MD, MSPH, co-lead author. "Healthcare workers' adherence to these recommendations is vital. Any weak link in the prevention chain can lead to excessive C. difficile cases."

To help combat the highly infectious bacteria, experts recommend creating a multidisciplinary approach that enlists a broad scope of hospital personnel, including leadership, healthcare professionals, lab personnel, pharmacy technicians, environmental services staff, and IT professionals to collaborate and implement effective interventions. Below are recommended strategies for hospitals and other acute care settings.

Encourage appropriate antimicrobial use and stewardship. This includes both avoiding antimicrobial exposures if a patient does not require treatment and selecting antibiotics that pose a lower risk for developing C. difficile, when possible. This is distinct from a formal antimicrobial stewardship program, which remains a special approach to antibiotic use. Use contact precautions. Hospitals are urged to treat patients with C. difficile in separate rooms from the general patient population and require healthcare professionals to don gloves and gowns whenever providing care to someone with confirmed C. difficile. It is also recommended that healthcare professionals use dedicated patient care items and equipment in this care. Practice hand hygiene. Because indirect transmission by healthcare professionals may be a major route by which patients acquire C. difficile, implementing protocol on hand hygiene is a crucial part of a successful prevention program. C. difficile differs from other drug-resistant bugs, such as MRSA and vancomycin-resistant Enterococcus (VRE) because it produces spores that are resistant to alcohol-based products. This makes wearing gloves and washing hands with soap and water before every encounter with infected patients extremely important. Hand hygiene protocols should be periodically measured to ensure compliance. Ensure environmental decontamination. Education of environmental support staff, including cleaning crews, is crucial to maintaining effective disinfection.. This includes proper cleaning of patient rooms and furnishings, equipment, and surfaces touched by healthcare professionals and patients. Conduct surveillance and performance measures. Implementing a laboratory-based alert system to provide immediate notification of newly diagnosed patients to clinical personnel will help frontline staff monitor for outbreaks. Additionally, creating reporting systems to capture the burden of the infection at a healthcare facility and assess efficacy of prevention interventions, such as hand hygiene and contact precaution, will help healthcare institutions to continually improve efforts.

The guidelines note several areas that require more research before making recommendations. Requiring use of gowns and gloves by family members and other visitors. Prescribing probiotics as a treatment against C. difficile. Using no touch disinfection technology. Restricting use of gastric acid suppressants.

The 2014 release updates the initial 2008 Compendium publication.

INFORMATION: Erik Dubberke, Phillip Carling, Ruth Carrico, Curtis Donskey, Vivian Loo, Clifford McDonald, Lisa Maragakis, Thomas Sandora, David Weber, Deborah Yokoe, Dale Gerding. "Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update." Infection Control and Hospital Epidemiology 35:6 (June 2014).

Published through a partnership between the Society for Healthcare Epidemiology of America and The University of Chicago Press, Infection Control and Hospital Epidemiology provides original, peer-reviewed scientific articles for anyone involved with an infection control or epidemiology program in a hospital or healthcare facility. ICHE is ranked 13 out of 158 journals in its discipline in the latest Web of Knowledge Journal Citation Reports from Thomson Reuters.

About the Society for Healthcare Epidemiology of America SHEA is a professional society representing more than 2,000 physicians and other healthcare professionals globally with expertise in and passion for healthcare epidemiology and infection prevention. SHEA's mission is to prevent and control healthcare-associated infections and advance the field of healthcare epidemiology. The society promotes science and research, develops expert guidelines and guidance for healthcare workers, provides high-quality education, promotes antimicrobial stewardship, encourages transparency in public reporting related to HAIs, works to ensure a safe healthcare environment, and facilitates the exchange of knowledge. SHEA upholds the value and critical contributions of healthcare epidemiology to improving patient care and healthcare worker safety in all healthcare settings. Visit SHEA online at http://www.shea-online.org, http://www.facebook.com/SHEApreventingHAIs and @SHEA_Epi.

About the Infectious Diseases Society of America The Infectious Diseases Society of America (IDSA) is an organization of physicians, scientists, and other health care professionals dedicated to promoting health through excellence in infectious diseases research, education, prevention, and patient care. The Society, which has more than 10,000 members, was founded in 1963 and is based in Arlington, VA. For more information, see http://www.idsociety.org.

About the American Hospital Association The AHA is a not-for-profit association of health care provider organizations and individuals that are committed to the improvement of health in their communities. The AHA is the national advocate for its members, which include nearly 5,000 hospitals, health care systems, networks and other providers of care. Founded in 1898, the AHA provides education for health care leaders and is a source of information on health care issues and trends. For more information visit the website at http://www.aha.org.

About the Association for Professionals in Infection Control and Epidemiology APIC's mission is to create a safer world through prevention of infection. The association's more than 15,000 members direct infection prevention programs that save lives and improve the bottom line for hospitals and other healthcare facilities. APIC advances its mission through patient safety, implementation science, competencies and certification, advocacy, and data standardization. Visit APIC online at http://www.apic.org. Follow APIC on Twitter and Facebook. For information on what patients and families can do, visit APIC's Infection Prevention and You website at http://www.apic.org/infectionpreventionandyou.

About The Joint Commission Founded in 1951, The Joint Commission seeks to continuously improve health care for the public, in collaboration with other stakeholders, by evaluating health care organizations and inspiring them to excel in providing safe and effective care of the highest quality and value. The Joint Commission evaluates and accredits more than 20,000 health care organizations and programs in the United States, including more than 10,300 hospitals and home care organizations, and more than 6,500 other health care organizations that provide nursing and rehabilitation center care, behavioral health care, laboratory and ambulatory care services. The Joint Commission currently certifies more than 2,000 disease-specific care programs, focused on the care of patients with chronic illnesses such as stroke, joint replacement, stroke rehabilitation, heart failure and many others. The Joint Commission also provides health care staffing services certification for more than 750 staffing offices. An independent, not-for-profit organization, The Joint Commission is the nation's oldest and largest standards-setting and accrediting body in health care. Learn more about The Joint Commission at http://www.jointcommission.org.