Hospital intestinal infections rising

WASHINGTON, D.C.; November 11, 2008

Oscar Carroll, 85, suffers from a potentially fatal bacterial infection that may be spreading to more people than ever before. His kidneys have shut down and he is on dialysis at a Florida hospital.

"In May he was admitted to intensive care and they didn't know what was wrong," his daughter Kathy Carroll-Josenhans told ABC News Monday. But she said things went downhill from there. She believes, once at the hospital, he was exposed to a bacteria called clostridium difficile, or C. difficile.

It is an infection that plagues its patients with diarrhea, dehydration and sometimes far more severe problems. Some say it could be the next superbug.

Highly contagious and often contracted once a patient is already in a hospital or nursing home, Carroll's infection is one that is far more prevalent than previously thought, according to a study released Tuesday. Researchers now think that on any given day, more than 7,000 hospitalized patients are infected with C. difficile. They also say that on any one day, an average of 300 patients may die from the infection.

The numbers from 648 hospitals, presented today at a conference of the Association of Professionals in Infection Control and Epidemiology, show that 13 out of every 1,000 patients are now infected, more than 60 percent higher than previous estimates by the Agency for Healthcare Research and Quality. And according to the study's principal investigator, William R. Jarvis, incidences of C. difficile could actually be far higher.

"Not only is it under-recognized and not tested for, but even when it's tested for, you have a 25 percent chance you're going to miss it," said Jarvis, president of Jason and Jarvis Associates, a private consulting firm in health care epidemiology.

The infection is springing up across various wards of hospitals, from cardiac units to pediatrics. It is transmitted when patients, health care workers and visitors touch items contaminated by feces. Patients who have taken antibiotics are especially vulnerable to getting sick from the bacteria because those antibiotics kill a patient's good bacteria and allow bad bacteria like C. difficile to multiply.

There are only a few drugs that treat C. difficile if caught in time. The convergence of several factors could explain why it's now on the rise.

"I think it's a combination of factors," Jarvis said. "One is that we know that our population is aging, and elderly patients are at the highest risk. We know that antibiotic use is increasing, that's a risk factor for this. And we know that there's been the introduction of a more virulent strain, which was first recognized up in Montreal, Canada, in Quebec."

Nearly 80 percent of those suffering from C. difficile in the study had taken more than one antibiotic prior to getting the infection.

"If you have a common viral infection during the winter, or a common cold, don't take antibiotics for it," Jarvis said. "You don't need them, it's not going to work. It's just going to put you at risk for getting something worse."

Washing hands is also imperative. The intestinal infection C. difficile can't be killed with alcohol-based hand gels. Instead, doctors say it's best for patients, visitors and health care professionals alike to wash hands with soap and water.

"If you don't see your doctor, if you don't see your nurse, if you don't see the person who's going to take your blood wash their hands before they come to take care of you, ask them," urged Dr. Brian Koll, chief of infection control at Beth Israel Medical Center.

He added that since launching intensive efforts to combat C. difficile, Beth Israel has seen a 75 percent decrease in infections during the last six months.

According to the Centers for Disease Control and Prevention, about 1.7 million cases of health care-acquired infections occur each year, causing an additional $4.5 billion in extra costs


To curb C. difficile in particular, a group of 37 hospitals have teamed up in New York to train staff, collect data and share what works in making patients less susceptible to the infection.

"The biggest challenge is to make it easy for everybody to do the right thing," Koll said. "Nobody comes into the hospital to work and give somebody an infection. We're really all here to really protect our patients."

That means wearing gloves, donning gowns and separating patients who may have the infection, to prevent it from spreading. To sterilize surfaces, like beds, furniture, even remote controls, it's also imperative to know that alcohol-based disinfectants won't work. The only thing that works is bleach.

Meantime, Carroll-Josenhans said that, although her family was advised to wash their hands with soap and water, they were not instructed to take other precautions.

"We were never told to wear gloves, we were never told to wear masks or gowns," she said. "We were simply there every day, one of us, and my father always had roommates that shared the same bathroom with him."

"He just wants to feel better," she added. "He said, 'I don't care if I ever work again. I don't care if I ever see another golf club. I just want to be out of pain, I want to come home, I just want to come home.' And that's all we want."

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