Watch what you touch: A bad germ gets worse

Making infection control a daily habit
The most important remedy is building infection control practices into the daily routine of organizations, said Koll, who is known for his work reducing potentially deadly central line-associated bloodstream infections.

Koll has spent the last two years improving prevention of C. diff in his hospitals, revamping protocols ranging from housekeeping techniques to quicker diagnosis.

"The minute somebody has diarrhea, you think 'C. diff'," he said.

Some changes have been obvious, Koll said. A switch from reusable rectal thermometers quickly contributed to C. diff rates that have fallen by 25 percent.

Key to a new collaboration with three dozen Northeast hospitals is a checklist of infection control steps and a “C. diff bundle,” a portable, prepacked kit of supplies that keeps health care workers from having to search for gowns, masks and necessary tools.

“People will do the right thing,” said Koll. “No one wants to give their patients an infection.” 

Avoiding C. diff Best advice is prevention — Wash your hands frequently with soap and water; alcohol sanitizers don't kill the C. diff bugs. Make sure to wash up before meals, after using the bathroom and after touching potentially contaminated surfaces.   — Ask visitors and health care workers to wash up, too. — Inquire about hospital cleaning methods. Do they clean twice daily and after fecal accidents? If C. diff is suspected, do they use chlorine-based cleaners? — If you have diarrhea, ask about a private room. A private toilet is ideal. — Make sure visitors and staff wear gowns and gloves when they enter the room. — Consider bringing a 1-to-10 solution of chlorine bleach to clean bedrails, call buttons, door knobs and other potentially contaminated sites. — Insist on daily bathing and fresh clothing. — Avoid use of antibiotics unless absolutely necessary. Source: CDC and msnbc.com research

It's long past time hospitals began to pay attention to their infection control practices related to C. diff, MRSA and other organisms, said Lisa McGiffert, director of the Stop Hospital Infections project for Consumers Union, a patient advocacy group.

Hospital-associated infections affect nearly 2 million patients and are associated with nearly 100,000 deaths each year, according to the CDC.

“Here’s the problem with these bad bugs: They’re very hard to stop when they get inside the body,” McGiffert said. “The only defense we have is prevention.”

Medicare may not pay for C. diff infections
It may take proactive efforts like those proposed by Koll and others to implement hospital-wide control practices. Or it may take punitive efforts, such as the move by federal Medicare officials to cut payments to hospitals for certain avoidable conditions acquired after admission. Last month, Medicare proposed adding C. diff to the growing list of preventable problems after the agency recorded 96,000 cases of the infection in 2007 at an average cost of $59,000 apiece.

In the meantime, patients need to take care into their own hands, often literally, advocates said.

They need to become acutely aware of hand hygiene, making sure to wash their own hands frequently and remembering to ask visitors and health care workers to wash up as well, said Betsy McCaughey, who heads the advocacy group Committee to Reduce Infection Deaths, or RID.

“No matter how dirty the hospital is, if that spore does not go in your mouth, you won’t get C. diff,” she said.

Some patients and their family members have become even more vigilant, bringing their own bleach-infused hand wipes to wash down hospital door knobs and bed-rails, said McGiffert.

“People are cleaning the bathrooms themselves because they’re filthy,” she said. “People have lost faith that the hospitals are going to do those things. They’re taking it on themselves.”

Officials with the CDC and APIC decline to recommend such forceful interventions because clinical studies haven't proven their effectiveness.

But even Donskey, the Ohio scientist, said his research has given him personal pause.

"I might bring along a bottle of bleach to disinfect my room and ask every health care worker who examines me to wash their hands, but I don't think most patients are willing to do that," he said.

Anxiety lingers, three years later
Nearly three years after her last bout with C. diff, Amy Warren said she does everything she can to avoid sources of the infection, including hospitals and antibiotics. She’s acutely aware that it took three doses of vancomycin, the strongest antibiotic available, to get rid of the bacteria after six months.

“If I get sick, I get a panic attack,” she said. "What if the vancomycin doesn't work? I have no other medicine."

She tries to warn friends and family about the dangers of C. diff, urging them to limit their use of antibiotics and to be vigilant about hand hygiene. But, she said, it's clear they're not listening.

"They think, 'How can diarrhea be that bad?'" Warren said. "But this is more than diarrhea."

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