Health care collaboration cuts C. difficile infections

Facilities in Clark, Cowlitz counties form task force

By Marissa Harshman, Columbian health reporter



What is Clostridium difficile?

Clostridium difficile — C. difficile, known as C. diff for short — is a germ that can cause diarrhea, fever, loss of appetite, nausea and belly pain. Those most at risk are people who take antibiotics and receive medical care. Older adults are especially vulnerable. While the rates of most health care-associated infections are declining, C. difficile infections remain at historically high levels.Some facts:C. diff-caused diarrhea is linked to14,000 American deathseach year.U.S. hospital stays from C. diff infections havetripled in the last decade.

A microscopic germ is becoming a gigantic problem at health care facilities across the United States.

While most types of health care associated infections are declining in the United States, one type — caused by the germ Clostridium difficile — remains at historically high levels. Hospital stays for C. difficile infections have tripled in the U.S. in the last decade, according to the Centers for Disease Control and Prevention.

In response to the startling figures, more than a dozen health care facilities in Clark and Cowlitz counties formed a task force to reverse the trend in the area. Since the task force formed in the fall of 2012, the rate of C. difficile infections in Southwest Washington has trended downward.

"A lot of areas of the United States are finding it to be catastrophic," said Dave Brantley, director of nursing at ManorCare Health Services-Salmon Creek. "And here we are reducing numbers."

In November 2012, right after the task force formed, the facilities reported a rate of 21.5 cases per 10,000 patient days. The rate started falling in December 2012 and continued its downward trend through 2013. In December 2013, the facilities reported a rate of 11.6 cases per 10,000 patient days.

"People want us to complete our jobs and get them home," Brantley said. "C. diff stops that from happening."

Tackling C. diff

C. difficile — or C. diff, for short — is a germ that can cause diarrhea, fever, loss of appetite, nausea and belly pain. Diarrhea caused by C. difficile is linked to 14,000 deaths in the United States each year, according to the CDC.

Those most at risk for developing C. difficile infections are people who take antibiotics and receive medical care. Older adults are particularly vulnerable. When a person takes antibiotics, the good germs that protect against infection are destroyed for several months. During that time, patients at health care facilities can get sick from C. diff picked up from contaminated surfaces or spread by a provider's hands, according to the CDC.

C. difficile spores can live outside the human body for a significant amount of time and can survive on things in the environment, including bed rails, linens, bathroom fixtures and medical equipment. Cleaning surfaces with bleach kills the spores and prevents the spread of C. difficile, according to CDC.

People with the infection are treated with antibiotics.

Alarmed by the high C. difficile infection rates, infection prevention staff from PeaceHealth Southwest Medical Center and Cascade Park Care Center, a skilled nursing and rehabilitation facility, came together to discuss strategies for bringing them down, said Debby Kelley, PeaceHealth Southwest's infection preventionist.

To really tackle the problem, though, meant getting other care facilities to come to the table as well, Kelley said.

"We have so many patients in common, it only makes sense to work together," she said.

So they started asking other health care facilities and hospitals to join the conversation. Month by month, more people showed up. Today, the task force includes three hospitals — PeaceHealth Southwest, Legacy Salmon Creek Medical Center and PeaceHealth St. John Medical Center in Longview — Clark County Public Health, American Medical Response, the Vancouver Fire Department and about a dozen care facilities.

The group meets monthly and typically draws 30 to 40 administrators, nurse managers and infection prevention workers.

"In health care, we're all working in silos," said Ben Young, administrator at ManorCare-Salmon Creek. "This was an opportunity for us to all come together."

The group realized gaps in communication between facilities — a hospital emergency department and a rehab facility, for example — meant information about patient infections wasn't always getting passed from one place to another, at least not in the most timely manner.

And that could mean moving the infection from facility to facility.

"This disease doesn't stay within the borders of nursing homes or hospitals," said Dr. Alan Melnick, Clark County Public Health director and health officer.

Rather than pointing fingers, the different facilities collaborated to create an infectious-disease transfer form. The bright orange form is the top sheet on patient charts and details any and all infections a patient acquires. That way, intake employees know right away that extra precautions need to be taken in a patient's care, Young said.

"That's been something that's been fantastic," he said.

In addition to the transfer form, the group emphasized education.

A hospital epidemiologist held classes at various facilities on C. difficile, detailing how the infection is spread and ways to prevent to it. The classes also highlighted indicators that a person may have C. difficile, so health care providers could detect and treat it earlier, Brantley said.

Members of the group also pushed for better hand-washing habits, creating slide show presentations and distributing posters at the facilities. They reinforced the use of best practices for cleaning a patient room after someone with C. difficile leaves, and they emphasized patient education on infection prevention, Kelley said.

Always another fight

The task force's work didn't stop with C. diff.

Next, the group homed in on influenza vaccination rates among health care workers. Employees who were vaccinated were given stickers for their name badges so patients and other employees could see who was protected, Young said.

This flu season, the employee vaccination rate at task force facilities was 89 percent.

And now, the group is turning its attention to viral gastroenteritis — an infection caused by a variety of viruses, such as norovirus — and preventing transmission at health care facilities. Every year, several care facilities experience gastroenteritis outbreaks, Melnick said. The task force is working on protocols to change that.

"The work they're doing is going to reduce the amount of transmission going on in the long-term care facilities," Melnick said. "I think that's pretty amazing."

The collaboration among facilities is something Melnick said he has yet to see in other communities. Some task force members are helping facilities in Oregon to replicate the group.

In the end, the patient benefits, Kelley said.

"It's all about making sure that people get the health care they need and they get safe health care," she said. "We don't want to make them sicker than they are."