Limited understanding of C. diff hinders prevention

AJIC study outlines doubt, confusion and misunderstanding among healthcare professionals
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Healthcare workers have limited technical understanding of Clastridium difficile, the most common hospital-acquired infection, but an understanding how providers make decisions about managing C. difficile risk also is lacking, new research finds.

In a study published Wednesday by the American Journal of Infection Control, researchers in Scotland reviewed 11 studies assessing how healthcare professionals' perceptions of risk and their responses toward C. difficile and methicillin-resistant Staphylococcus aureus (MRSA). Only four of the studies specifically addressed C. difficile.

In all four cases, technical knowledge of the bacterium was deemed poor, especially among doctors and nurses. The limited knowledge encompassed microbiologic aspects of the bacterium, risk factors, diagnosis, treatment and prevention. One study found senior physicians and nurses knew even less about C. difficile than trainees. Two of the studies found that doctors and nurses worried about risk to their own health from exposure.

One of the studies found doubt among nurses about the effectiveness in measures such as hand hygiene and use of aprons in preventing spread of the infection, and confusion over the rationale for infection prevention when they saw inconsistent compliance with the measures. The main reason for confusion was a lack of detail in infection-prevention policies and education, but another study found limited staff understanding even with better prevention education.

By contrast, healthcare professionals had a much better understanding of MRSA, the studies found.

"There is a need to build on the efforts of risk perception research from other disciplines to understand how health care professionals think and make decisions about C difficile," the researchers concluded. "This can help inform the development of effective management and communication strategies to maximize the quality of care provided."

The study comes a day after the release of a survey by the Association for Professionals in Infection Control and Epidemiology (APIC) finding that infection and death rates from C. difficile remain at historic highs in spite of increased efforts to prevent infection. APIC publishes the American Journal of Infection Control.

Although 70 percent of infection preventionists surveyed said their healthcare facilities have added C. difficile infection-control interventions since March 2010, infection rates fell at only 42 percent of their facilities. Another 43 percent saw no decrease, the survey found.

Meanwhile, an article in the April issue of the journal Infection Control and Hospital Epidemiology found six major risk factors for a C. difficile infection relapse: Patient age, exposure to fluoroquinolone in the 90 days before diagnosis, an intensive care unit stay within 30 days before diagnosis, and exposure to cephalosporin, a proton pump inhibitor or metronidazole after diagnosis.

To learn more:
- read the AJIC study abstract
- here's the Infection Control and Hospital Epidemiology abstract

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