Maine ranks second in the nation for deaths from a nasty infection spread in health care facilities, according to new data.
The bug, called Clostridium difficile, is a gastrointestinal bacteria that most often strikes people who are both taking antibiotics and receiving medical treatment. The infection is linked to 14,000 deaths each year nationwide, according to the Centers for Disease Control and Prevention.
Maine’s mortality rate from the germ is 5.5 deaths per 100,000 people, second only to Rhode Island, where C. difficile results in 8.2 deaths per 100,000 people, according to Extending the Cure, a Washington, D.C.-based project on antibiotic resistance funded by the Robert Wood Johnson Foundation.
The ranking is based on 2007 data. It shows the highest death rates from C. difficile in the Northeast.
Dr. Stephen Sears, Maine state epidemiologist, said the Extending the Cure data was dated, but stressed that C. difficile remains a serious concern in Maine.
“It’s very common and very severe and it’s causing problems for people,” he said.
Maine began seeing more deaths from C. difficile in 2006, following an outbreak of a virulent and more toxic strain of the bacteria in Canada, Sears said.
Infection and death rates from C. difficile have reached historic highs while other health-care-related infections are on the decline. Deaths related to the infection jumped 400 percent between 2000 and 2007, according to the CDC.
C. difficile appears to have eclipsed Methicillin-Resistant Staphylococcus aureus, an antibiotic-resistant “superbug” that has wrought havoc on hospitals.
“By most people’s examination it’s become a bigger problem than MRSA,” Sears said.
C. difficile causes diarrhea that can progress to sepsis and death, particularly among the elderly. It can exist in the body without causing illness.
When a person takes antibiotics, good bacteria in the gut are killed off, leaving a ripe environment for C. difficile to grow, Sears explained. If that person then visits a hospital, nursing home or other health facility, they can pick up the germ from contaminated surfaces or a health care provider’s hands.
The C. difficile bacteria produces a hardy spore that can linger in dust and dirt, Sears said. Especially troubling is that alcohol-based hand sanitizers don’t kill the germ.
“The spores are extremely resistant,” Sears said. “You have to actually use bleach to clean them.”
C. difficile has traditionally been associated with hospitals, but a CDC report released this week shows that just a quarter of infections show up in hospital patients. The rest appear in nursing home patients or people recently treated in doctors’ offices and clinics.
“A lot of C. difficile is in long-term care,” Sears said. “That’s a reflection of the health care system, because that’s where sick people on antibiotics go.”
The germ can spread as patients transfer back and forth among various health care facilities.
Hospital stays related to the bacteria add at least $1 billion in extra costs to the health care system, the CDC estimates.
C. difficile is treated with, ironically, antibiotics specifically targeted to the bacteria.
“Antibiotics are the cause and antibiotics are the cure,” Sears said.
Key to preventing the infection is avoiding unnecessary antibiotics and frequent hand-washing, he said. Patients taking antibiotics should also check with their doctor if they develop diarrhea, Sears said.
The CDC found that C. difficile prevention efforts in Massachusetts, Illinois, and New York hospitals have cut infections by 20 percent in under two years.
Maine outpaced many other states last year by passing new legislation that requires reporting of C. difficile infections following hospital admissions, Sears said.
Hospitals began submitting that data in January. The figures won’t become publicly available until after a months-long validation process by health officials.
In 2008, a consortium of Maine hospitals banded together to work toward preventing health-care-related infections.
“A lot has been put into place to try to minimize C. difficile, but a lot more can be done,” Sears said.
nothing like an article that uses 5 year old data. Must have been a slow news day.
really…
Sadly the 2007 data isn’t much different today. C Difficile is not responding to the steps that Hospitals are taking to stop infections. There are many steps that must be taken to lick this problem. One is patients need to stop expecting to get antibiotics for every sniffle or cold, and doctors need to stop giving them. Second, other Multi drug resistant organisms need to be brought under control and that includes infections like MRSA. This must be done with aggressive preventative measures that not all Hospitals follow. When we are forced to give the strongest antibiotics to treat these horrible infections, C Diff can be the result. Third…we need to stress the need for regular handwashing rather than alcohol hand sanitizers for use by both healthcare givers AND patients. This bug is spread by oral fecal route from person to person. Fourth, any patient with undiagnosed diarrhea should be isolated until C Diff is ruled out, and finally, we need to start using bleach products in Hospitals/Long term care centers to clean. It takes Bleach to kill C diff. These are just some of the steps necessary to stop these horrible deadly germs from harming patients.
These pervasive and deadly infections are preventable. It takes aggressive preventative steps and collaboration with patients and their families and visitors to stop these deadly bugs.
VERY well said and informative, Kathy! I’m assuming you are a healthcare provider of some sort as I am. Everything you said is TRUE.
I am an RN and now a volunteer patient safety activist. I started my activism after my own father died of Hospital Acquired MRSA pneumonia, after being admitted to his small rural hospital for a minor ankle fracture. Nobody should have to go through what my father and my family went through, so I work very hard to make healthcare safer.
I appreciate your comment. I think all people involved in Health Care should be Acticist as you are. I often feel I am nothing more than a number, in work, life and at the doctor. Keep up the good work!
I am sorry for your loss.Thank you for saving lives!
Thank you for what you do.
I am also in healthcare and I know what you went through Kathy with your Father. My Mother was in Boston for a heart valve evaluation for surgery. She was placed in 3 different rooms each roommate tested positive for MRSA, but not until after she had been in their rooms for several days. Needless to say, she developed MRSA and the much needed heart valve surgery was turned down because of the infection. I lost her less than six months later due to complications created by the MRSA. It is a nasty infection and I advise everyone, if you do not need to or unless it is life or death, do not go to the hospital and take the chance of contracting MRSA and C-Diff. I am an advocate for the elderly for ER and the hospital setting. Everyone needs an advocate that will assist ill individuals in understanding how to navigate the health care system as well as stay safe and healthy. Hats off to you Kathy.
I’m very sorry about your Mom. I know how it feels to watch a loved one go from ambulatory, independent and engaged to becoming a completely bed bound, complete care patient because of preventable infections. One thing I have not mentioned here is that I advise patients to request a private room. That doesn’t’ mean you will get one, but make that request. If you don’t get one, and your roommate appears to be infected with something or you overhear that they are……become the squeaky wheel. Get moved out….moving them without serious environmental cleaning will not save you from the infection….the bug is already in the room. Cross contamination from one patient to another is much more common that we are lead to believe. My father had no infection when he went into the Hospital. Then he had 3 roommates (at separate times) who had respiratory ailments, all died. None were ever screened for pervasive and highly infectious MRSA or other organisms (that I am aware of), yet the Hospital claims that he was not roomed with anyone who had MRSA. That is an absolutely impossible statement to make without actual screening. Sharing bathroom facilities, and the air in a room with an infected roommate can make you sick. Respiratory MRSA can be coughed up to 5 feet away. That is about as far as you would be from a roommate in any of the Maine Hospitals I have been in.
We do need Hospitals to save us from horrible ailments and injuries, but they are dangerous places to be. Becoming educated and empowered can help patients to avoid the dangers that lurk there. Anyone who is interested in forming an independent Patient and Family advisory council please let me know. kathydayrn@aol.com
Proton pump inhibitors have also been linked to increased prevalence of C. diff. How many of your patients are currently taking one?
OP is correct. The alcohol hand sanitizers are _ineffective_ against C. diff. Good ol’ soap and water has always been the gold standard for mechanically removing the bacteria.
Do you know why Maine’s rate is so high? The article doesn’t seem to explain that.
I can’t positively answer that question, but the fact that we have a very large elderly population could be part of the answer. The vast majority of deaths caused by C Diff are in people over 65.
This is really scary stuff. I agree with what you are saying 2000% my Mom almost died from C-Diff after being in a rehab facility in Ellsworth. If we had not instisted that she be put back in the hospital where she then went into cardiac arrest she would have died in the in nursing home.
People need to wake up and understand that too much precaution like antibiotics for a viral infection and using hand sanitzers and antimicrobial soaps are actually killing us.
I would like to add that family members and friends visiting patients in the hospital need to take this seriously and gown and glove when they enter isolation rooms. I took care of too many people who’s family members would be indignant about my suggesting they wear protective gear because no matter what I said, they felt I were saying THEY were infectious, not the patient. People need to know that if they visit someone in a nursing home or hospital and touch and hug their loved one, getting c diff spores on their clothing, that they can transmit the bacteria when they leave. I haven’t worked in a hospital setting in a while so I don’t know if it’s changed, but if you don’t gown up, you don’t visit. Plain and simple.
You are absolutely right. These Multi drug resistant infections are a public health problem. That means it “takes a village” to stop them. Handwashing should be done by all patient’s visitors before and after visting, whether they are in isolation or not. And, beyond that. Patients also need to keep their hands clean. It is hard for people to understand that handwashing and precautions protect both themselves and the patient. On an even larger scale, those two things protect the community. We are living in a time when we dont’ have a new antibiotic to throw at every type of infection anymore. We need to concentrate on prevention, prevention of spread of known disease, a cleaner patient environment and antibiotic stewardship.
They aren’t “battling” this. They are the cause of it. It’s simple asepsis. Handwashing and
barriers. It’s hands, and pens, and charts. The medical profession should be deeply ashamed. They aren’t fit. There is *no reason for a nosocomial infection. The battle is on laziness and ignorance.
Require mandatory aseptic procedure training and start assigning responsibility, per room. This is one of the largest public health threats in our country, and there are no excuses.
Eat yogurt when you are taking antibiotics- helps replace the good bacteria being killed off in your gut.
Having recently been at Maine Medical Center in Portland a handful of times, I was shocked by their reliance on alcohol-based hand sanitizer. Medical personnel only seemed to wash their hands when asked to do so and even then, I got an eye roll.
That’s because the Centers for Disease Control says hand sanitizer is acceptable to use unless hands are visibly soiled, which is when soap and water should be used. In fact, the CDC says alcohol sanitizer is superior to soap (plain or antimicrobial) in some instances. The exception is in known cases of c. difficile, which requires soap and warm water to be removed. Unfortunately, many hospitals now have sinks with laser-operated faucets. That’s good, in that no one has to touch the faucet, but that’s bad, because the water never runs long enough to get warm, let alone hot.
I respect the CDC, but I also question them. If hand santizers do not kill C Diff, they why do we rely on them almost exclusively in Hospitals and other HC settings? Not all C Diff is “known”. Patients may not be tested and or diagnosed for days after admission when they have acute diarrhea and during that time they are very contagious. It is the “unknowns” that cause risk and spread of disease. Wasn’t that the premise of Universal Precautions? So, if that is the case, then perhaps returning to actual hand washing is the answer to some of our problems wiht Hospital and Healthcare acquired infections. It makes me curious…..hand sanitizers became accepted and the preferred method of hand cleansing around the late mid to late 90s…..then between 2000 and 2007, we had an alarming increase in HAIs. Maybe it is time to take another look at hand sanitizers. It seems we were doing better before we started using that little squirt of alcohol based hand santizer. I’d rather rely on good old soap and water.
I agree…I think that Hand sanitizers are over used with some people. They become addicted to using them which in turn can lower their immune system. I feel that good old hand washing to the elbows and rinsing with clear water is the safest method. The health care facilities should have stations available for people to wash with hot water. I think we were doing much better before the alcohol based sanitizers. I agree with you……
I’m afraid the only “gutting” issue Maine hospitals and nursing homes are suffering from is inflicted from Augusta!!
This can happen at any age, this is from long term use of antibiotics. My son had this when he was 12. This is a nightmare. No parent should have to go thru this.. His weight dropped quickly and he fell off the growth chart. This can happen at any time and at any age. not just from nursing homes or hospitals. And it takes a long time to recover. if you have a family member that has been sick and that is taking antibiotcs they need to see the provider and get this check.
You are absolutely right when you say anybody can get this, not only nursing home or Hospital patients. Most cases are related to recent antibiotic use and healthcare. However, the vast majority of deaths caused by C Diff are in people over 65 years old.
I have worked in skilled nursing for over 10 years and 5 years ago this was a major problem, but in the past 2-3 it has not been as many cases. Our plan when someone has this is the hand sanitizers are removed from the room and bleach is used to disinfect and many other precautions are taken to prevent the spread. Hand washing is promoted rather than the use of sanitizers. Many who work in health care often have very dry hands because of washing them so frequently.
Seriously? Having dry hands is better than spreading deadly illnesses from person to person.
I didn’t mean that having dry hands was horrible but it does mean that most of us wash our hands a lot. We don’t want to bring these germs home to our families or spread them to the other residents.
Does anyone reading this article think that a community based patient and family advisory council to bring community concerns and ideas to our Healthcare providers, would be a good idea. Massachusetts has had these for several years.
And Mass. is considered among the healthiest states in the country.
Absolutely Kathy….voices belonging to patients and community members who are represented by informative professional people introducing concerns regarding health issues to Healthcare Providers as well as Nursing Homes, and Hospitals; would be a wonderful service. I always call it “Bridging the Gap between the Docs and the patients.” Do we need to go to Augusta? Ha!
I think we can do this right here in Bangor. I have found that if you go for legislation, way too much time is wasted with technicalities. If we do something locally and do it well, we can make a difference.
Hand washing, hand washing, hand washing…that still remains the best defense and people just don’t do it.
http://ygn.me/quN8bj8
“C. difficile is treated with, ironically, antibiotics specifically targeted to the bacteria.”BS, the 5 or so antibiotic options for treating C. difficile infection kill a whole lot more than just C. difficile. And THIS is exactly the problem.”“Antibiotics are the cause and antibiotics are the cure,” Sears said.”Isn’t this what they’ve been doing all along ? Working real well, isn’t it ?The medical community can be glaringly incompetent, too, and this situation is an example of that remarkable incompetence.
Flagyl an antibiotic and Cholestyramine are what got rid of C-diff for me.
I had C-diff three times, starting in 2006 after an operation. After the hospital I was in rehab in a nursing home. The day after I came home I started with the diarrhea and went to the ER and was admitted with C-diff. This disease is so bad that you wish you would die. After being in isolation and then finally getting better, I went to another nursing home for rehab. I then went back to the hospital with C-diff again. While in isolation the only person that washed their hands with soap and water was the person who drew blood from me. The others, nurses and aides all used the sanitizer. I always used soap and water. I dropped 20 lbs during this time and was so weak I could hardly walk. After the third bout with C-diff, I finally am rid of it, Thank God. I had a person come in and clean my home with bleach before I came home the last time and it evidently worked. I am very cautious on taking antibiotics and tell my Dr. that. I learned I wasn’t the only one in the hospital with C-diff so it is very common.
http://safepatientproject.org/posts/3009-cdc-warns-the-public-about-deadly-c-diff-infections-patient-safety-advocates-react
The Consumer’s Union Safe Patient project is the group I affiliate with. This is another great article about C Diff.
PLEASE!!! Due to the stringent enforcement of HIPPA there are many of us working with people with C-Dif who do not have a clue!! I recall working with a resident one night when
another nurse said what if he has MRSA? I replied well they would have told us, right? She said, not necessarily. C-Dif is no different.
If you are working in a facility that is not informing their healthcare employees that they will be working with patients that are infected with MRSA/STAPH and C-DIFF and take the necessary precautions, that facility needs to be reported immediately. Not only are you at risk, but every person you come in contact with including other patients, and your own loved ones young and old become potential victims of these horrible infections.
Wash your hands, wash your hands, wash your hands. There is a protocol to properly wash your hands, sing “Happy Birthday” slowly. And I mean soap and water.Alcohol wipes on anything you must take out of the room like pens/stethoscopes. Leave it there if you can. I’m always a little skeptical of how much bacteria must be residing on the alcohol based sanitizers themselves. I suspect a LOT.
Besides employees, patient families also need to wash their hands. And probably one of the most forgotten hand washing is to wash the patients’ hands as well. Very often this gets overlooked, which allows bacteria to further spread and colonize.