APIC: Hospitals struggle on in C. diff fight

Issues with environmental cleaning

Hospitals have expanded their environmental cleaning programs to respond to the epidemic of Clostridium difficile, but many are unaware whether patient rooms and environmental surfaces are actually being decontaminated, the Association for Professionals in Infection Control and Epidemiology reports.

The Association's 13,000 members were asked to complete an online survey designed to determine if additional C. diff  interventions have been adopted since the release of APIC's "National Prevalence Study of Clostridium difficile in U.S. Healthcare Facilities" in November 2008. Nearly 1,800 members took the survey; three-quarters of respondents work at acute care facilities. Eighty-six percent of respondents have increased environmental and equipment cleaning and decontamination during the past 18 months, but when asked how they monitor cleaning practices, nearly seven in 10 (69%) said they rely on observation versus more advanced hygiene monitoring technologies. Nearly a quarter (23%) do not monitor the effectiveness or outcomes of environmental cleaning efforts. Other APIC findings include:

  • C. diff interventions are up, as more than half of respondents (53%) have adopted additional measures in the last 18 months to prevent and control the spread of the pathogen.
  • Though interventions have increased, a third of respondents (34%) believe their facilities should be doing more to prevent and control C. diff.  
  • Less than a quarter of respondents (23%) have been able to add more infection control staff in the last 18 months.
  • Eighty-three percent currently have hospital-wide hand hygiene programs. Nearly nine in 10 (89%) use unannounced hand hygiene observations to measure compliance. A third of programs (33%) include consequences for non-compliance.
  • Ninety percent perform surveillance for C. diff infections. Only 29%, however, monitor the number of colectomies performed at their institution, and nearly half (46%) do not now know if their rate of colectomies has increased. The number of colectomies has increased with the emergence of the virulent NAP1 C. diff strain.
  • Patient education is lagging. More than three-quarters of respondents (77%) have recently initiated staff education programs; two-thirds (66%) educate visitors and family members, but only 50% educate patients about C. diff.