March 25, 2017

By: Nargis Abdelmessih, MSN, RN

The catastrophic threat of Clostridium difficile

Clostridium difficile (C. diff) is becoming a common microorganism in the healthcare systems and poses a catastrophic threat to the United States. It costs the healthcare system up to billions of dollars, leading to serious complications and higher mortality rates per Centers for Disease Control and Prevention (CDC). Caring for C. diff patients is becoming burdensome, time consuming, and overwhelming for nursing staff. It doesn’t just negatively impact patients, but also family members and organizations.

I have worked as a nurse for 16 years in hospitals, long-term care facilities, and as a hand hygiene observer in conjunction with the infection prevention department at the Ohio Hospital Association. During that time, I have seen healthcare workers walking out of rooms with C. diff patients without washing their hands. Once an infection prevention physician tried to argue the necessity of clinicians washing their hands, even when they didn’t touch anything in the room. More than once I asked different healthcare workers, why do we have to wash our hands when caring for C. diff patients and they couldn’t answer.

Earlier in my nursing career, I admit to the lack of knowledge on C. diff infection. At one of the long-term care facilities where I worked, every time we had a C. diff case, more cases were diagnosed within days. I noticed a pattern: Isolation precautions were only applied in the infected patient’s room, not in physical therapy or the dining room. Infected patients had therapy in the same room as uninfected patients. No isolation precautions were used in the physical therapy room with infected patients, and the same equipment was shared with uninfected patients. I wondered why isolation precautions were only applied in patient’s room, but not outside the rooms, which reflected the lack of knowledge on how C. diff spreads and the infection precautions for this organism. A lack of education was an issue in that facility, not only on that topic but in general. Also in all the jobs, I have held as a nurse, I only have seen few cases where the family used the personal protective equipment.

The problem of resistance

I live in Ohio and work at one of the Cleveland Clinic Hospitals, which is ranked as one of America’s top two hospitals by U.S. News & World Report. Through the years, I have witnessed the growth of the staff development department, using innovative teaching strategies educating healthcare workers. The effort, time, and money spent to prevent the transmission of C. diff are undeniable. Cleveland Clinic leaders are actively working on decreasing the number of C. diff cases, by hiring external hand hygiene observers, conducting ongoing monitoring of the compliance with infection precautions by the infection control department, and installing the electronic monitoring devices in some sites. The clinic has done a great job through the years, improving the hand hygiene rates. However, I personally believe there is more work needs to be done, including educating healthcare workers on the urgent threat of C. diff.

When I worked as a hand hygiene observer, I faced so much resistant from staff. Let’s just say that on certain units, I wasn’t the most favorable person to see for some of the staff. I have heard harsh comments by some of the staff, making fun of what I did, mostly by the ones who were nonadherent. I always wondered if those healthcare workers understood the consequences of not practicing hand hygiene caring for C. diff patients, including the risk of death. Although I was supposed to be invisible, after many times it was hard to stay unnoticed. I found that many of healthcare workers lacked the knowledge of how the infection spreads, how long bacteria lives on hard surfaces, why and when to wash their hands. I found inconsistency of what they know, some expressed their frustration of not being properly educated on the issue.

A call for action

Healthcare workers, patients, and visitors have a crucial role in preventing the transmission of C. diff infection in hospitals and reducing the number of cases. Tracking compliance with the infection prevention policy, using internal or external hand hygiene observers, using electronic tracking devices, spending money on equipment are all important. Without the proper education and training, C. diff infection and mortality rates will continue to rise. Soon C. diff infection will evolve into an epidemic that will pose major a threat to healthcare systems. Thus healthcare leaders need to come together as a team, create a standardized training program that serves healthcare providers, patients, and families. It’s also necessary to increase communication and collaboration among healthcare team members.

Nargis Abdelmessih works at the Cleveland Clinic in Ohio. The views expressed are her own.


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