C. diff next infection on VA system radar

Patient screening would not be a focus

Applying the considerable power of infection control interventions across more than 150 hospitals nationwide, the Veterans Affairs (VA) system is planning to target Clostridium difficle in its next major initiative, Hospital Infection Control & Prevention learned.

The striking results of the VA program against methicillin-resistant Staphylococcus aureus (MRSA) are still being analyzed, but the data clearly underscore the massive research power the network of hospitals can provide in adopting and analyzing a set of interventions.

The interventions will have to be different, as the patient screening component of the MRSA program has no clear corollary in a program for C. diff. The former is a common bacteria of the skin, while the latter is an enteric pathogen that presents a whole different set of challenges.

A leading cause of diarrhea in hospitalized patients, C. diff infection can lead to serious complications such as pseudomembranous colitis, toxic megacolon, perforations of the colon and sepsis. According to CDC data, hospital-acquired C. diff — which includes both hospital-onset cases and post-discharge cases that occur up to 4 weeks later — causes some 215,000 infections annually, which result in 12,000 deaths and costs of $1.6 billion.

"It's a different disease and there is much less data on how you intervene for C. diff," says Gary Roselle, MD, one of the principal investigators in the VA MRSA project and an infectious disease physician at the Cincinnati VA Medical Center. "There is not as much information to design a bundle. There is a group that is looking into this and again there will be an attempt to intervene and improve care."

In the last few years the epidemic of C. diff in VA hospitals and other facilities has been driven by the highly virulent NAP1 strain, which is more deadly to patients and six-fold more prevalent than the next most common C. diff strain. Basic infection control measures include hand hygiene and gloving, but C. diff is notoriously difficult to remove from the environment and is practically impervious to the alcohol hand rubs now ubiquitous in hospitals. The idea behind the VA project is to use the infrastructure put in place for MRSA to try and prevent C. diff infections.