American Hospital Association
Health Research & Educational Trust

Clostridium difficile Infection (CDI)

Importance: Clostridium difficile is an anaerobic, spore-forming bacteria spread through fecal-oral transmission (Leffler & Lamont, 2015). C. difficile colonizes the large intestine and releases two toxins that can cause a number of illnesses including diarrhea, colitis and sepsis. Nonetheless, colonized patients do not always present symptoms. C. difficile transmission in hospitals occurs primarily from contaminated environments and through the hands of healthcare personnel (Cohen et al., 2010; Guerrero et al., 2012). However, C. difficile spores are resistant to the bactericidal effects of alcohol and the most commonly used hospital disinfectants. Antimicrobial therapy is the most important risk factor for C. difficile infections; the antibiotics destroy normal gut flora, allowing for the overgrowth of C. difficile. While all patients taking antibiotics are at risk of C. difficile infections, longer courses of antibiotic therapy and multiple courses of antimicrobials increase C. difficile infection risk. C. difficile is the most frequently reported hospital-acquired pathogen (Leffler & Lamont, 2015). A 2011 CDC surveillance study found that C. difficile caused almost half of a million infections and directly led to approximately 15,000 deaths in one year (Lessa et al., 2015). The majority of these deaths occur in Americans aged 65 or older. Learn more about the impact of CDI on patients.

Additional healthcare costs related to C. difficile infections are estimated at $4.8 billion for acute care facilities alone (Dubberke & Olsen, 2012). Cases commonly appear in outbreaks and clusters (Burdon, 1982). However, the CDC study estimates that only one-quarter of C. difficile infections occur in hospitals, with others occurring in nursing homes and community settings (Lessa et al., 2015). As a result, C. difficile infection prevention efforts should focus on antimicrobial stewardship and preventing disease transmission.

PfP Goal: By September 23, 2018, each participating HIIN hospital reduces CDIs by at least 20 percent.

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