Managing Antibiotics

Facts about C. difficile

•    C. difficile is a spore-forming bacteria that, without proper cleaning, can survive on surfaces for many weeks.
•    Like other bacteria, C. difficile is most commonly transferred via the hands of health care workers who do not practice hand hygiene.
•    Bleach-containing solution is the best agent to disinfect C. difficile-contaminated surfaces.
•    The incidence of C. difficile is growing fast, doubling from 31 cases per 100,000 people in 1996 to 61 per 100,000 in 2003.
•    C. difficile may cost the nation’s hospitals more than $1.1 billion annually.
•    Mortality rates from C. difficile in the U.S. increased from 5.7 per million population in 1999 to 23.7 per million in 2004.


As an adjunct to the C. difficile Collaborative, the Fund and Greater New York Hospital Association (GNYHA) managed two projects to help health care facilities implement programs to guide the appropriate use (and prevent overuse) of antibiotics. Studies suggest that such stewardship programs can improve clinical outcomes and may reduce C. difficile infections, which can be deadly and present a range of major concerns for health care providers and patients alike.

In the first project, which was funded by the New York State Department of Health, three hospitals participating in the C. difficile Collaborative partnered with three long-term care facilities and collaboratively tested programs to manage antibiotic use. The partnering between acute and long-term care facilities was a key aspect of the project because transitions between health care facilities present special challenges.  Partners included Lutheran Medical Center and Lutheran Augustana Center for Extended Care and Rehabilitation, North Shore University Hospital and the Stern Family Center for Extended Care and Rehabilitation, and St. Catherine of Siena Medical Center and St. Catherine of Siena Nursing Home. The partnering facilities formed interdisciplinary teams responsible for implementing a range of practices, such as developing guidelines for diagnosis, treatment, and duration of antibiotic therapy to treat infections; identifying dose-optimization strategies; and determining the optimal list of antibiotics to include in each hospital's formulary. The project participants also developed an extensive toolkit supporting the basic development of an antimicrobial stewardship program. 

In the second, and complementary, project, the Fund and GNYHA collaborated with Boston University and Montefiore Medical Center (whose participation was funded by a grant from the Agency for Healthcare Research and Quality) to determine the effectiveness of different antibiotic management strategies in reducing C. difficile infections. A group of ten hospitals was split into intervention and control groups. The intervention group implemented select stewardship practices, which involved specific antibiotics or classes of antibiotics. Rates of C. difficile infection and antibiotic use were measured before, during, and after the interventions. All ten hospitals were also participants in the C. difficile Collaborative, and they will continue to assess infection rates and take part in the development of tools and best practice guidelines for use by other organizations. The project also analyzed costs and conducted other associated evaluations, and produced a toolkit, available on the website of the Agency for Healthcare Research and Quality, to assist hospital staff and leadership in developing an effective antimicrobial stewardship program with the potential to reduce C. difficile.

Project Contact: Deborah Halper


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