C diff, Clostridium difficile might be passing MRSA, or methicillin-resistant staphylococcus aureus as the bug to watch

Clostridium difficile, commonly referred to as C diff, is a bacterium that can cause symptoms ranging from diarrhea to inflammation of the colon that can be life-threatening, and it appears to be on the rise in hospitals, nursing homes, and long term care facilities.

MRSA, or methicillin-resistant staphylococcus aureus, was once considered to be a serious infectious threat in hospitals and health care facilities, causing approximately 18,000 deaths annually. While MRSA still presents a huge problem, C diff is on the rise, and like MRSA, is drug-resistant to some antibiotics. Additionally, C diff is showing up in people who have not been hospitalized.

Dr. Becky Miller, an infectious diseases specialist at Duke University Medical Center presented results from a research study on Saturday at a medical conference on infection in health care facilities. The 2008 and 2009 study conducted at community hospitals in four states showed hospital-acquired C diff infection rates 25 percent higher than MRSA rates.

Symptoms of C diff include watery diarrhea three or more times a day lasting for more than two days and mild abdominal cramping and tenderness. Signs and symptoms of severe cases of C diff are watery diarrhea 10 to 15 times a day, severe abdominal cramping and pains, fever, nausea, blood or pus in stool, dehydration, loss of appetite, and weight loss.

The bacteria is passed in feces and spread to food, surfaces and objects when infected people do not wash their hands thoroughly. The germs can survive for months and can linger on surfaces such as telephones and remote controls.

Studies Show Significant Increases of C. Difficile Infections (CDI)

Pennsylvania Patient Safety Authority data shows almost 40 percent of gastrointestinal infections in nursing home patients are CDI related and bloodstream infection risk reduction strategies in PA health facilities are questioned.

Clostridium difficile infections (CDIs) are quickly becoming a significant issue in healthcare based upon recent studies. Preliminary data collected from nursing homes and highlighted in a Supplementary Pennsylvania Patient Safety Advisory shows that almost 40 percent of gastrointestinal infections reported are CDIs.

"Our first look at infection data submitted from Pennsylvania nursing homes confirms what prior studies have found in hospitals -- C. diff infections are a real problem in healthcare institutions," Mike Doering, executive director of the Pennsylvania Patient Safety Authority said. "Elderly patients are particularly at risk because of their age and their use of hospitals and nursing homes where the infection can spread more easily."

The Agency for Healthcare Research and Quality's Healthcare Cost and Utilization Project showed that from 1993 to 2001 hospital discharges with CDI increased by 74 percent (from 85,700 patients annually to 148,900). CDI cases nearly doubled from 2001 to 2005 with a 102 percent increase in patients discharged with CDI (from 148,900 to 301,200).

Clostridium difficile infection is caused by a spore-producing bacterium in the Clostridia family. It is the most common cause of healthcare-associated infectious diarrhea in healthcare facilities. The elderly or people receiving antibiotics are more likely to develop a CDI. Many people may not realize they have C. difficile until it is too late.

"The elderly or people taking antibiotics are at an increased risk for developing CDI," Doering said. "C. difficile can develop because of the antibiotics. Unfortunately, for some, they do not realize the diarrhea they are experiencing can be much more serious than a case of food poisoning or brief illness.

"Patients can die from these complications if they are not treated right away," Doering added.

Doering said data from the Pennsylvania Healthcare Cost Containment Council (PHC4) also shows increases in CDI. Pennsylvania hospitalizations from CDI increased from 7,026 cases in 1995 to 20,941 cases in 2005. The hospitalization rate for CDI increased 173 percent from 1995 to 2005.

"Education is the key for fighting these infections," Doering said. "Healthcare facilities and nursing homes need to implement infection prevention strategies and educate all staff, including housekeeping personnel, about effective C. diff prevention strategies that have been proven to work.

"Patients must also be properly educated about C. difficile when discharged, so they know what to expect at home," Doering added.

The Authority began collecting infection data from nursing homes in June 2009. The preliminary data analyzed was collected from nursing homes July 1 through September 30, 2009.

For more information on CDIs, risk reduction strategies and consumer tips go to the 2010 March Supplementary Pennsylvania Patient Safety Advisory article "Clostridium Difficile Infections in Nursing Homes," on the Authority's Web site at www.patientsafetyauthority.org.