Hospitals struggling against 'C. diff' bacteria

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A microscopic image shows "C. difficile" bacteria, a tough opponent.

'You just feel so sick you want to die," said Marion Costa, 77.

More than a decade ago, the Red Bank, N.J., resident was stricken with a stubborn, yet largely preventable, bacterial infection called Clostridium difficile.

Health officials had been sounding the alarm well before 2003, when Costa came down with the potentially lethal bug, called C. diff for short, and they have been doing so ever since. But hospitals have made little progress, a new analysis by Consumer Reports suggests.

One-third of U.S. hospitals fall short when preventing this type of infection, including several in the Philadelphia area, the magazine found.

The number of cases reported by hospitals declined 8 percent from 2011 to 2014, but that is still well below the goal of a 30 percent reduction set by the U.S. Department of Health and Human Services. And in most states, health departments do not review patient medical records to ensure data accuracy.

Why is it such a tough opponent?

And should you be worried?

A big part of the problem is that for part of their life cycle, the bacteria take the form of dormant, but very rugged, spores. In this encapsulated form, the bacteria cannot be killed by those hand sanitizing foams and gels that you see on every hospital hallway. Only a good scrubbing with soap and water does the trick.

And on hard surfaces such as handrails and toilets, the spores must be killed with heavy-duty weapons such as bleach or ultraviolet light. The bug is easily transmitted from hand to mouth, and those with a severe infection may suffer a litany of miseries, including frequent watery diarrhea that may become bloody, plus fever, abdominal pain, nausea, even kidney failure. According to the CDC, one in 11 older people with the infection dies within a month.

The Consumer Reports analysis was based on data submitted to the U.S. Centers for Disease Control and Prevention, which is publicly available from the Centers for Medicare and Medicaid Services at www.hospitalcompare.hhs.gov.

Four area hospitals reported worse-than-average rates of C. diff for the most recent data-collection period, the 12-month period ending Sept. 30, 2015.

They included three in Philadelphia - Hahnemann University Hospital, the Hospital of the University of Pennsylvania, and Nazareth Hospital - and St. Mary Medical Center in Langhorne. All hospitals in the New Jersey suburbs made the grade on C. diff, as did Riverview Medical Center, where Costa suffered her bout in 2003.

Health quality experts caution against comparing hospitals based on just one indicator.

"It's a starting point," said Sharon Bradley, a senior infection prevention strategist at ECRI Institute, a Plymouth Meeting-based nonprofit that evaluates medical devices and health-care hazards.

All four of the area hospitals with worse-than-average C. diff performance scored better on Consumer Reports' overall safety ratings, a composite of multiple infection rates, readmissions, and other patient-safety indicators. All were in the middle range.

The C. diff scores, which are part of that overall safety rating, are expressed as a ratio of how many cases a hospital gets compared with how many are expected. The latter calculation is based on a range of factors, including size and whether the hospital is affiliated with a medical school, which tends to increase the number of cases.

Nationally, hospitals tend to see a half-dozen such cases per 10,000 patient days. Often the problem starts when patients are on antibiotics for some other illness. This rids the gut of certain bacteria, leaving a clear path for C. diff to take hold.

First-line treatment consists of other kinds of antibiotics that are effective against C. diff. Some physicians eventually resort to a procedure called a fecal transplant in order to recolonize the patient's gut with healthy bacteria.

Older patients and those with compromised immune systems are more likely to get the bug. And it is relentless: One out of five patients who get over the illness comes down with it again.

The four lower-scoring area hospitals all said they were taking strong steps to prevent infections, including restricting antibiotic use when not needed. The federal data that Consumer Reports analyzed are more than a year old, and the hospitals said they were seeing improvement since then.

"C. diff is absolutely the hardest thing I've ever had to do in my entire life in terms of trying to fix this," said Ronald Goren, chair of infection prevention at both St. Mary and Nazareth.

Neil Fishman, associate chief medical officer of the University of Pennsylvania's health system, cautioned that the hospital uses an unusually sensitive method for testing patient samples, so its rate of cases might appear higher than at some other hospitals.

Still, Penn takes the bacteria very seriously, having invested in robots that disinfect rooms with ultraviolet light, he said.

tavril@phillynews.com
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@TomAvril1