Mass. teams help reduce spread of often fatal germ

A life-threatening germ that causes diarrhea and spreads easily from doctors’ offices to hospitals and nursing homes has climbed to historic highs nationally, federal disease trackers warned Tuesday, as they pointed to efforts in Massachusetts that have helped slow the rate of infections here.

The Clostridium difficile bacteria, also known as C. difficile, is linked to about 14,000 deaths a year nationwide, and the number of hospitalized patients with a C. difficile-related diagnosis more than doubled between 2000 and 2009, from approximately 139,000 to 336,600, health officials said. During that same period, other health-care-associated infections have declined.

“C. difficile is a formidable opponent, but one that we can stop,’’ said Dr. Clifford McDonald, an epidemiologist with the US Centers for Disease Control and Prevention and lead author of a study that has tracked the rise of the lethal bug. He spoke during a conference call with reporters to call attention to the spread of the germ and highlight ways to stop it.


The federal officials pointed to a campaign involving 71 hospitals in Massachusetts, New York, and Illinois that drove down infections from C. difficile by 20 percent in less than two years.

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In Massachusetts - where the bacteria was blamed for at least 156 deaths in 2009, the most recent state numbers available - 27 hospitals created diverse teams, from cleaning crews to lab technicians, and achieved even better results.

The 18-month initiative reduced C. difficile infections by 25 percent, said Paula Griswold, executive director of the Massachusetts Coalition for the Prevention of Medical Errors, the organization that led the state’s campaign. It has since been expanded to about 70 nursing homes, but federal funding for the project runs out in July, she said.

“The hope is that we have stimulated something that will keep going, even in the absence of funding,’’ said Dr. Madeleine Biondolillo, director of the bureau that oversees hospital and nursing home safety for the Massachusetts Department of Public Health.

Those most at risk of C. difficile infections are people who have taken antibiotics and who receive care in any medical setting, federal health officials said.


Antibiotics are life-saving medicines that stop infections, but they also destroy the body’s good bacteria for several months. During this time, patients can get sick from C. difficile picked up from contaminated surfaces or spread from a health care provider’s hands.

A patient is 7-to-10 times more at risk of developing a C. difficile infection while taking an antibiotic and for one month afterward, said the federal study.

Almost half of infections occur in people younger than 65, officials said, but more than 90 percent of deaths occur in people 65 and older.

C. difficile is challenging to stop, in part because its spores resist killing by usual hospital disinfectants and require a special cleanser.

The Massachusetts hospital teams devised easy-to-follow approaches to help tamp down the germ’s spread, such as hanging gowns and gloves on the front of an infected patient’s door so health care providers could don them easily before treating the patient.


The teams included family members of patients who died of C. difficile, and project leaders had them bring in their pictures.

“It helps to have the front line staff be reminded that this is a serious infection with serious consequences,’’ said Griswold.

In addition to reducing transmission of the infections, the Massachusetts initiative also focuses on smarter use of antibiotics. Overuse and misuse of antibiotics contribute to a growing number of drug-resistant germs, which has worried disease trackers because the pipeline for new antibiotics that are effective against these germs is running dry.

Dr. Stuart Levy - professor of medicine, microbiology, and molecular biology at Tufts University School of Medicine - said the concern is particularly acute in nursing homes, because residents often have several illnesses and the setting is ripe for transmission.

“This is just one example in which antibiotics can do more harm than good and resistance is an increasing problem,’’ said Levy, president of the Alliance for Prudent Use of Antibiotics, an international organization.

Levy is slated to testify before Congress Thursday about the rise of antibiotic-resistant germs in the nation’s hospitals and food supply.