What’s the diff? It’s just a spore, right? Sure. Just some old spore whose toxin producing strains can cause a spectrum of disease ranging from mild or moderate diarrhea to its most advanced form known as pseudo- membranous colitis, which can lead to toxic dilation of the colon (megacolon), sepsis, and death. It’s Clostridium difficile infection (CDI), or C-diff, and it is rapidly becoming one of the most significant issues in healthcare.

Data from a study conducted by the Agency for Healthcare Research and Quality’s Healthcare Cost and Utilization Project over an eight year period from 1993 through 2001reveals that nationwide there was a dramatic 74 percent increase in the number of hospital discharges with CDI. This pales in comparison to the more than doubling (102 percent) increase over the following four year period of 2001 through 2006.

More recently, a 2008 study was conducted by Jarvis, Schlosser, Javis et.al. in which they developed and distributed a survey to all Association for Professionals in Infection Control and Epidemiology members. This sample population represents somewhere in the neighborhood of 12.5% of all U.S. acute care facilities in the United States. Their data suggested the overall prevalence of CDI to be 13.1 per 1,000 inpatients.

A 2007 Pennsylvania study conducted by the Pennsylvania Health Care Cost Containment Council (PHC4) was used to examine the prevalence of CDI within that state. The evidence diagnosed a near tripling of hospitalizations related to the disease over the ten year period from 1995 through 2005. Unfortunately for those hospitalized, their stay in the facility was two and a half times longer than their fellow patients who were not infected. The cost of the extended stay was also more than double than that for the CDI free patients. And in the end, patients with CDI were four times more likely to die than patients without CDI, not adjusted for other conditions. That’s far from “just another spore!”

Similar studies have been conducted in Maryland and Ohio. The Maryland study focused on an LTC facility affiliated with an academic medical center. Results revealed that the incidence of CDI ranged from 0 to 2.62 cases per 1,000 resident days. Colonization rates in residents in the absence of a recognized outbreak have ranged from 4% to 20%. This study also revealed that going to the hospital may actually be bad for your health as the evidence suggested that an additional 10% to 20% of residents may acquire the organism during their stay.

Ohio State University teamed with the Ohio Department of Health in 2006 to conduct a study to describe the epidemiology, disease burden, and mortality rate of healthcare onset CDI in hospitals and nursing homes. What they found was that during that year 11,200 nursing home cases (6,900 initial and 4,300 recurrent cases) of healthcare onset CDI occurred in nursing homes. The nursing home rate for initial cases was 1.7 to 2.9 cases/10,000 patient days. The rate of recurrent cases ranged from 0.8 to 2.4 cases/10,000 patient days. Apparently, nursing homes can also be bad for your health.

This is a nasty bugger whose preferred domicile seems to be healthcare facilities. So what’s a hospital to do? In future entries we will discuss this in more detail, with topics such as risk factors and prevention. Until then, wash your hands!

Data in this entry was found in an article entitled Clostridium Difficile Infections in Nursing Homes from Vol. 7, Suppl. 1—March 18, 2010 of the Pennsylvania Patient Safety Advisory.

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