C. Diff: Deadly Infection on the Rise in U.S. Hospitals

Consumer Reports' new Ratings show many teaching hospitals fail to prevent this deadly disease

By Hallie Levine
Last updated: March 04, 2016
consumerreports.org

A life-threatening bacterial infection is gaining ground in America’s hospitals, according to a new report from the Centers for Disease Control and Prevention. And a Consumer Reports analysis finds that even some of the nation’s largest and most prestigious medical institutions are having a hard time getting it under control.

The infection, called C. diff (Clostridium difficile) sickened 101,074 hospital patients in 2014, the most recent data available, according to a March report from the CDC. Other research shows that overall about 450,000 people a year, inside and out of hospitals, are sickened by the infection, and it contributes to the death of about 29,000 people.

"New data show that far too many patients are getting infected with dangerous bacteria in healthcare settings,” said CDC director Tom Frieden, M.D. “Doctors and healthcare facilities have the power to protect patients—no one should get sick while trying to get well," he said.

While several serious hospital-acquired infections, such as those caused by central-line catheters, have declined in recent years, C. diff. rates increased by 4 percent between 2013 and 2014, according to the CDC.

And Consumer Reports’ updated Ratings of more than 3,200 hospitals across the country show that many are doing a poor job of reining in the infection. Overall, about a third of them received a low Rating in combating the infection. That means they have C. diff infection rates that are worse than the national benchmark.

That includes 24 of the nation’s largest teaching hospitals, including familiar ones such as Baylor University Medical Center in Dallas, the Cleveland Clinic in Cleveland, Cedars-Sinai Medical Center in Los Angeles, Johns Hopkins Hospital in Baltimore, and Mount Sinai Hospital in New York City. “Teaching hospitals are supposed to be places where we identify the best practices and put them to work,” said Lisa McGiffert, director of Consumer Reports' Safe Patient Project. “But even they seem to be struggling against this infection,” she said.

While about 28 percent of hospitals nationwide earned one of our top two scores in preventing the infection, only four of them were large teaching hospitals: Harris Health System in Houston, Maine Medical Center in Portland, Maimonedes Medical Center in Brooklyn, N.Y., and Mount Sinai St. Luke’s - Mount Sinai West in New York City.

(See the chart below for a complete list of low-scoring large teaching hospitals. And check our free hospital Ratings to see how your local hospitals score on infection prevention for five different types of infections and other key safety measures.)

How C. Diff Spreads

There are two important reasons why C. diff is hard to control in U.S. hospitals.  

First is the misuse of antibiotics in hospitals, said Erik Dubberke, M.D., associate professor of medicine in the Division of Infectious Diseases at Washington University in St. Louis and a spokesman for the Infectious Diseases Society of America. “Those drugs are obviously lifesaving when used appropriately, but they can also make you vulnerable to C. diff,” he said. That’s because those drugs can kill off the “good” bacteria that normally grow in your stomach, allowing bad bacteria, including C. diff, to spread.

About half of all hospitalized patients receive antibiotics during their stay—even though up to 50 percent of such prescriptions are unnecessary or inappropriate, according to the CDC. Particularly worrisome is when patients are given powerful “broad-spectrum” antibiotics, such as ciprofloxacin (Cipro and generic) and levofloxacin (Levaquin and generic), which are meant to act against a variety of disease-causing bacteria at once, instead of drugs that target specific bacteria. That increases the chance of developing C. diff, because those drugs are more likely to kill off the body’s good bacteria along with the bad.

The second reason is poor hygiene. C. diff, which is found in fecal matter, is easily passed from person to person on the hands of healthcare workers—and can survive on door knobs, bed rails, and other surfaces for weeks.

Proper hygiene—including washing hands and, especially, wearing gloves—can cut the spread of the disease. But less than a third of healthcare workers in intensive care units always wash their hands, according to a 2014 University of Iowa study. And a Consumer Reports survey of 1,200 recently hospitalized people found that only about half always saw their doctor or nurse wash their hands.

“Doctors and nurses get busy, and they sometimes simply forget to rewash their hands every time they walk into a new patient’s room,” said Louise-Marie Dembry, M.D., professor of medicine and epidemiology at Yale University and president of the Society for Healthcare Epidemiology of America.

What Hospitals Say

Representatives of some of the low-scoring teaching hospitals in our Ratings say that institutions like theirs face special challenges in combating C. diff.

For example, they may see sicker patients than non-teaching hospitals, said Craig Civale, a spokesman for Baylor University Medical Center. “As a major academic hospital in an urban setting, BUMC routinely admits very complex patients with multiple conditions,” he said. A spokeswoman for Cedars-Sinai Medical Center offered a similar explanation for its hospital's C. diff infection rate, and also notes that it sees an unusually large number of older patients, who are at increased risk of the infection.

Another factor may simply be that teaching hospitals detect more cases of the disease than do other hospitals, because they test and report more carefully, said Lisa Maragakis, M.D., senior director of health care epidemiology and infection control for the Johns Hopkins Health System.

Still, hospital officials acknowledge that C. diff. is a serious problem, and that they are responding by changing their practices. “The results reported by Consumer Reports are disappointing to us,” said a spokeswoman for Mount Sinai Hospital in a statement. Mount Sinai also said that it has recently established a task force to look into the hospital’s infection rates, and is investigating “evidence-based practices targeted to reduce all healthcare-associated infections.”

At Baylor, the hospital is developing new protocols to ensure that antibiotics are prescribed appropriately, Civale said. Johns Hopkins is taking similar steps, and is also instituting “rigorous hand hygiene and environmental cleaning initiatives,” Maragakis said. In addition to to those steps, Cedars-Sinai now tests all patients with diarrhea for C. diff, a spokeswoman for the hospital said. And in a statement to Consumer Reports, the Cleveland Clinic noted that the hospital is “committed to continuous improvement in quality and safety.”

What You Can Do

If you (or family members or friends) are in the hospital, here’s what you can do to reduce your risk of developing a C. diff infection:

• Make sure you really need that antibiotic. If your doctor wants to give you an antibiotic, ask why. If he suspects an infection, he should do a rapid culture, if possible, to quickly pinpoint the possible bacteria so that he can prescribe the most effective antibiotic at the lowest dose. 
• Watch out for heartburn drugs. Hospital patients are sometimes prescribed heartburn drugs called proton-pump inhibitors such as omeprazole (Prilosec and generic) and esomeprazole (Nexium and generic) to ease stomach pain. But those medications can also increase the risk of C. diff infections taking hold in your stomach. So if your doctor suggests you take one of those drugs while in the hospital, ask why. 
• Insist on hand-washing and gloves. Ask everyone who walks into your room whether they’ve washed their hands—if they’re doing it at your sink, make sure they scrub for 40 to 60 seconds. Also check that they are wearing gloves. Rubbing on alcohol-based hand sanitizer is not strong enough to destroy C. diff, Dembry said. 
• Ask about the hospital’s protective measure: Hospitals should order a C. diff test for any patient who has diarrhea (three loose stools within 24 hours), said the CDC. Anyone with diagnosed C. diff should be put in a single room, and healthcare providers should wear gloves and gowns when treating that patient.