43rd ICAAC Conference

What’s the C-difference? Oh, $15,000 an infection

Plus HCV transmission risks, bugged phones

(Editor’s note: As this issue of Hospital Infection Control went to press, these studies were presented in Chicago at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Look for more in-depth coverage of this conference in our next issue.)

Compared to a noninfected control group, patients with Clostridium difficile-associated diarrhea had prolonged hospital stay, higher severity of illness, increased hospital costs, and were more than three times more likely to die. Targeted efforts to reduce this infection would have major economic benefits and improve patient outcomes, emphasize researchers at Baptist Memorial Health Care Memphis, TN.1

Patients with C. difficile infection had an average increase in total hospital costs of $15,180, including an additional $3,237 in medication costs. C. difficile-associated diarrhea is a common cause of hospital-acquired diarrhea in the United States.

Overuse of antibiotics frequently is identified as the primary risk factor for developing C. difficile diarrhea, although individual patient factors such as advanced age and severity of illness also are risk factors. Unfortunately, the overall impact on health and economic outcomes has not been well characterized.

The researchers hypothesized that patients who developed C. difficile-associated diarrhea were more likely to have worse outcomes, including longer and more costly hospitalizations. The primary objective of the project was to identify the impact on economic and health outcome measures at a large, tertiary-care, community hospital.

Overall, 118 patients who developed C. difficile-associated diarrhea during the study period were identified and matched to control patients with identical discharge diagnoses and no evidence of the condition. Medication and total hospital cost data were extracted from hospital financial records. Diagnosis categories were obtained from an aggregated diagnosis-related group (DRG) coding system Compared to patients without C. difficile-associated diarrhea, the infected patients had a longer length of stay (21.8 vs. 7 days), including intensive care unit length of stay (5.7 vs. 1.3 days); increased severity of illness; and higher mortality (13.9% vs. 3.6%).

Profile of HCV risk

A major European study looking at occupational risks of hepatitis C virus has determined the highest risk candidate for seroconversion is a male clinician exposed to high-titer HCV-infected blood via a deep needlestick. The study was performed to identify factors that influence HCV transmission to health care workers after occupational exposure to the virus.2 It was conducted in five European countries. The study included 60 health care workers who seroconverted after HCV exposure (cases) and 204 HCV-exposed health care workers who did not seroconvert (controls).

The risk of HCV transmission to health care workers after accidental needlestick injuries increased when: the worker who performed the procedure was male, the worker was exposed to a patient with a high HCV titer, and the injury to the worker was deep and caused by a needle that had been placed in that patient’s vein or artery, researchers found.

The risk of transmission increased threefold when the health care worker was male, 88-fold when the injury was deep, and 22-fold when it was caused by a needle that had been placed in a patient’s vein or artery. However, transmission only occurred when the patient to whom the health care worker was exposed was viremic.

Health care workers long have been recognized to be at risk of hepatitis virus infection through occupational exposure to blood and blood-contaminated objects. HCV transmission to health care workers carries a high risk of subsequent disease. The risk of chronic hepatitis is more than 70% after acute infection; more than 20% of patients later develop cirrhosis; and 1% to 4% may develop hepatocellular carcinoma, the researchers warned. In addition, HCV transmission may jeopardize a health care worker’s medical practice. The identification of transmission risk factors is important for establishing recommendations to manage exposures, the European study concluded.

Is your phone bugged?

Ubiquitous cell phones certainly carry the potential for transmitting resistant bacteria from hospital personnel to patients through hand-phone interaction, warned researchers at Soroka University Medical Center in Beer-Sheva, Israel.3 Cellular phones are used widely in many Western countries and are a standard means of communication. Consequently, cell phones often are used by hospital staff during work hours, either for personal reasons or as a means of communication instead of classic paging systems.

In the study, epidemiologists cultured the hands and cell phones of 124 staff (71 physicians and 53 nurses). They found Acinetobacter on 12% of phones and 24% of hands, and 10% of Acinetobacter isolates were multiresistant. Cell phone contamination was most notable among staff of internal medicine wards, while positive hand cultures were most notable in pediatric wards. There was no relation between reported hand-washing practices and risk for positive cultures.

Antibiotic-resistant bacteria are a major threat to patient health while being treated in the hospital. Acinetobacter baumannii is a bacterium that has the propensity for developing resistance to almost any of the available antibiotics and may survive for long time periods on inanimate objects. Resistant bacteria commonly are cross-transmitted between patients during repeated contact between individuals and caring personnel. This phenomenon may be prevented by a variety of means; the most notable is hand washing with antiseptic solutions. Because of the intimate contact between personnel hands and cell phones, it is plausible to assume that phones may be involved in the chain of transmission of resistant bacteria within institutions. But this issue has not been studied previously.

Therefore, cell phone use by personnel should be considered when designing infection prevention strategies. Soon the researchers intend to study the actual rate of staff-patient transmission via cell phones by genetic profiling of bacteria obtained from the phones, personnel hands, and infected patients. Meanwhile, cell phone use during patient care has been prohibited in the institution.

References

1. Suda K. Health and economic outcomes of hospitalized patients with clostridium difficile-associated diarrhea. Abstract K734. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago; September 2003.

2. Yazdanpanah Y. Factors that influence the risk of hepatitis C infection after occupational exposure to HCV Abstract V772. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago; September 2003.

3. Borer A. Can cellular phones of hospital personnel be involved in transmission of resistant bacteria to patients? Abstract K-745. Presented at the Interscience Conference on Antimicrobial Agents and Chemotherapy. Chicago; September 2003.