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Got Scary Germs?

September 24, 2008
by Mark Hagland
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As health writer JoNel Aleccia reported earlier this year in an article on MSNBC.com, Ohio mother of two Amy Warren experienced stomach cramping so severe she felt as though she was still in labor, followed by uncontrollable diarrhea that left her weak and raw. It took four tests to find out the truth: Warren was among growing numbers of Americans sickened by an especially virulent form of the bacterial infection Clostridium difficile, popularly known as C. Diff. “It’s like a science fiction disease,” said Warren, who struggled for six months and three relapses before controlling the infection.

Unfortunately, Amy Warren is far from alone these days. In fact, the latest federal Centers for Disease Control and Prevention figures show that between 2000 and 2005, infections caused by C. diff more than doubled, with 301,200 cases of C. difficile-associated disease (CDAD) logged in by U.S. hospitals, with 28,600 patients dying from it. Federal officials add that when nursing homes and other patient care sites are included, the number of cases nationally is now closer to 500,000. “We’ve been trying to sound the alarm repeatedly since 2004 that the trend is continuing upward,” Cliff McDonald, a CDC epidemiologist told The Wall Street Journal last week.

Here’s the interesting part: many patients acquire C. diff infections as a consequence of taking antibiotics for other illnesses, as the bacteria normally found in a person’s intestines help keep C. diff under control. As a result, hospitals are monitoring and limiting antibiotic use more closely now. What clinicians really need in this context is two things. First, they need the clinical tools associated with the EMR—both the patient record element, and the clinical decision support element—in order to better track infections and better deal with them. On a broader level, the healthcare system as a whole needs more extensive coordination of the kinds of tools and systems that will help public health leaders better track what’s going on in the country with infections, and better alert healthcare provider organizations and the public on emerging and urgent trends.

Hospitals, as everyone already agrees, also need to better crack down on poor hygiene and sanitation habits. “The biggest problem in our hospitals is that they are filthy dirty,” Dr. Alfonso Torress-Cook told MSNBC.com earlier this year. Toress-Cook, an epidemiologist, told the media outlet that he had already adopted practices that cut C. diff infections by 90 percent at his acute rehabilitation center in Orange County, California. “If we start cleaning the environment, the infection will take care of itself,” he added.

Hospital and health system CIOs will need to be a part of the discussion both around clinical information systems, obviously, but also the discussion with clinician leaders and facility managers around such topics as purchasing ultraviolet light machines to curb infections, and including building infection control check-ins at appropriate points of care (such as ensuring handwashing prior to inserting central line catheters).

Given the risk to both individual patient and public health, as well as the potential costs involved, infections like C. diff need to be taken seriously, lest we all end up the sicker—and sorrier—for not having acted.

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