Sick from the Hospital? CR evaluates risk of C. diff. infection.

Oct 24, 2016

2 Prominent Boston Hospitals named to Consumer Reports’ “Worst” list for having high C. diff. Infection Rate

by Ingrid A. Halstrom, Esq.

MGH
Image Credit: Boston Herald

You don’t go to the hospital, especially a hospital with the prestige of Massachusetts General Hospital (MGH) and Brigham and Women’s Hospital (BWH) (both Partners teaching hospitals) and expect to worry about catching a potentially deadly bacterial infection. But according to a September 27, 2016 article by Consumer Reports, MGH and BWH ranked in the bottom 19 out of 229 large teaching hospitals for having an infection rate worse than the national benchmark. Consumer Reports defined large teaching hospitals as those with at least 500 beds and 200,000 patient days over the reporting period. Between October 2014 and September 2015, there were 298 C. diff. infections at MGH and 212 infections at BWH.

Image Credit: Boston Herald
Image Credit: Boston Herald

In fact, this is the second time that MGH and BWH have received a low score from Consumer Reports for C. diff. prevention; both hospitals received a low score when this measure was looked at in March 2016. According to Lisa McGiffert, director of Consumer Reports’ Safe Patient Project, “Teaching hospitals are supposed to be places where we identify the best practices and put them to work…but even they seem to be struggling against this infection.”

Dr. Tom Frieden, director of the Centers for Disease Control and Prevention (CDC) told Consumer Reports, “Far too many patients are getting infected with dangerous bacteria in healthcare settings.”

The Boston Herald’s  Lindsay Kalter reported the results of the Consumer Reports article on September 28, 2016. According the Herald article, MGH Chief of the Infection Control Unit Dr. David Hooper stated that the data used by Consumer Reports did not account for the cases of infection acquired before the patient arrives. Further, the Herald article attributed Dr. Debbie Yokoe, medical director for Infection Control at BWH with stating that the hospitals also use a sensitive C. diff. test, which can lead to an inflated number of cases.

What is C. diff.? A deadly infection.

Clostridium difficile bacterium
Clostridium difficile bacterium Image Credit: CDC

C. diff., otherwise known as clostridium difficile is a bacterium that causes inflammation to the colon in affected people and is classified as a hospital acquired infection by the Centers for Disease Control. Symptoms include watery diarrhea (at least three bowel movements per day for two or more day), fever, loss of appetite, nausea, and abdominal pain/tenderness. In 2011 almost half a million people had a C. diff. infection and 29,000 died within 30 days of initial diagnosis. Twenty percent of people infected with C. diff. have a recurrence of the disease.

Who is at risk? How is it spread?

People who have been prescribed antibiotics for prolonged periods for other medical conditions, especially broad-spectrum antibiotics, and the elderly are at a greater risk of acquiring C. diff

C. diff. spores are shed in fecal matter. People can become infected with C. diff. if they touch items or surfaces that are contaminated with feces and then touch their mouths or mucous membranes. Any surface, device, or material that becomes contaminated with feces may serve as a C. diff. contamination site. Examples include toilets, bath tubs, electronic rectal thermometers, or even surfaces such as bedrails and doorknobs. C. diff. spores can live for long periods of time, even weeks, on contaminated surfaces.

According to the CDC’s Patient Information page, patients mainly contract C. diff. via the hands of healthcare professionals who have touched a contaminated surface or item.

How can it be prevented?

handwashing
Hand-washing with soap for at least 40-60 seconds Image Credit: lipscomb.edu

According to the CDC, 94% of C. diff. infections occur in hospitals and other healthcare settings. To prevent C. diff. infections the CDC recommends:

  • Improving the prescription of antibiotics.
  • Using best tests for accurate results to prevent spread.
  • Rapid identification and isolation of patients with C. diff.
  • Healthcare providers wear gloves and gowns when treating patients with C. diff. (hand sanitizer doesn’t kill C. diff.).
  • Cleaning room surfaces with EPA-approved, spore killing disinfectant (such as bleach), where C. diff. patients are treated.

cdiff-one-pager

What can you do?

Patients should ask everyone who walks into their room whether they’ve washed their hands with soap (alcohol based hand sanitizer isn’t strong enough). If the healthcare provider is washing their hands in your room, make sure they are scrubbing for at least 40-60 seconds. Also, check to make sure your healthcare provider is wearing gloves.

How did other Mass. Hospitals measure up?

Of the fifty-nine (59) Massachusetts hospitals recently rated by Consumer Reports, 30 scored in the bottom two tiers of the rating system on avoiding C. diff. infections. Only 29 Massachusetts hospitals scored at or above the national benchmark. In additional, only 8 Massachusetts hospitals earned one of Consumer Reports’ top two scores, meaning their infection rates were at least 50% better than the national benchmark (in alphabetical order): Clinton Hospital, Fairview Hospital, Adcare Hospital of Worcester, Emerson Hospital, Harrington Memorial Hospital, Holyoke Medical Center, Massachusetts Eye and Ear Infirmary, and New England Baptist Hospital.

In addition to Massachusetts General Hospital and Brigham and Women’s Hospital, other Massachusetts hospitals that scored in the bottom 2 tiers of a recent Consumer Reports Hospital Rating for avoiding C. diff. infections include (in alphabetical order): Berkshire Medical Center, Beth Israel Deaconess Medical Center (Plymouth, Milton, and Boston locations), Beverly Hospital, Boston Medical Center, Brigham and Women’s Faulkner Hospital, Cambridge Health Alliance, Cooley Dickinson Hospital, Good Samaritan Medical Center, Hallmark Health System (Melrose), Holy Family Hospital, Lahey Hospital & Medical Center (Burlington), Milford Regional Medical Center, Morton Hospital and Medical Center (Taunton), Mount Auburn Hospital, Nashoba Valley Medical Center (Ayer), North Shore Medical Center, Norwood Hospital, Saint Anne’s Hospital (Fall River), Sturdy Memorial Hospital (Attleboro), Tufts Medical Center, UMass Memorial Medical Center (Worcester), and Lawrence General Hospital.

According to the Consumer Reports article, Lawrence General Hospital had the lowest rating for C. diff. prevention in Massachusetts.

Sources:

Centers for Disease Control and Prevention: https://www.cdc.gov/HAI/organisms/cdiff/Cdiff_infect.html

Consumer Reports Hospital Ratings: http://www.consumerreports.org/health/doctors-hospitals/hospital-ratings/ratings/search-results.htm?state=MA

Consumer Reports C. diff Infection rates: http://www.consumerreports.org/doctors-hospitals/consumer-reports-names-hospitals-with-high-c-diff-infection-rates/

Boston Herald: http://www.bostonherald.com/news/local_coverage/2016/09/2_boston_hospitals_on_worst_list