Clostridium difficile (C. diff) is a germ that can cause severe diarrhea and disease of the intestines, sometimes leading to death. C. diff infection (CDI) of the large colon can be so severe on occasion that it needs to be surgically removed. Elderly persons, and ill patients requiring long term use of antibiotics are susceptible to these infections. Antibiotics change the balance of bacteria normally found in the intestines and creates an opportunity for C. diff to grow and cause CDI. “LabID Events” are CDIs that were identified in acute care hospital inpatients by counting culture samples tested by laboratories

The Standardized Infection Ratio (SIR) is the primary measure used to track healthcare associated infections by the Connecticut Department of Public Health. The ratio is the number of actual infections that occur in a given time (called the baseline period) divided by the number predicted. The baseline is 1.0, which means that the number of infections observed is the same as the number predicted. If the SIR is greater than 1.0, it indicates that more HAIs were observed than predicted; conversely, an SIR less than 1.0 indicates that fewer HAIs were observed than predicted.  As the aim is to reduce CDI, we aim to reduce the SIR below 1 (the lower, the better).

SIR for CDI in Connecticut acute care hospitals has been steadily declining since 2014, indicating that infection prevention efforts in the hospitals have been effective.

Hospital medical and non-medical staff, especially infection prevention and control staff (infection preventionists and hospital epidemiologists). Connecticut Hospital Association. Qualidigm, the Connecticut CMS Quality Improvement Organization (QIO). The Connecticut Healthcare Associated Infections Advisory Committee. The Connecticut Chapter of the Infectious Diseases Society of America (CIDS). Centers for Disease Control and Prevention, Division of Healthcare Quality and Prevention. National Healthcare Safety Network. Council of State and Territorial Epidemiologists. The Association of Professionals in Infection Control, Inc. The Society for Healthcare Epidemiology in America. Connecticut Department of Public Health.  

By properly using antibiotics only when necessary and only to the extent needed, CDIs can be prevented. Antimicrobial (antibiotic) stewardship programs aim to accomplish this through careful tracking of antibiotic use, training of healthcare providers that prescribe antibiotics and patients about the need of proper antibiotic use, and limits on the use of certain antibiotics. CDIs can also be prevented by careful cleaning of the environment and careful handwashing by healthcare workers, especially in nursing homes and hospitals. To implement these practices, healthcare facilities must track use of the best practices, and ensure that all staff involved in prescribing antibiotics, direct patient contact, and cleaning of the healthcare facility rigorously adhere to them, despite the many competing priorities they address every day to care for patients.

Many facilities have adopted the best practices after participating in prevention collaboratives, where groups of different healthcare facilities meet to share ideas about how to implement and maintain best practices to prevent C. diff infections. We will continue to monitor CDI LabID Event data to assess the effectiveness of this intervention.