Tuesday, June 20, 2017

C. difficile as a Hospital Acquired Condition: Time to Give it a Rest

As is well known, C. difficile infection is classified as a CMS Hospital Acquired Condition (HAC). 

The current state of infection prevention science can likely prevent 55-70% of device associated infections and surgical site infections, as cited hereC.difficile is different. Although a compendium of strategies to reduce C.difficile in the hospital was recently published by my colleagues at SHEA, the extent to which hospital acquired C.difficile is truly preventable is unknown and highly debatable.

First, the paradigm that most C. difficile is hospital acquired was challenged by the New England Journal of Medicine article by Eyre et al, demonstrating that diverse reservoirs of C. difficile exist outside of the hospital setting, likely contributing to the rise in current cases.

Recently, our Swiss colleagues demonstrated that to C. difficile can be controlled without the use of contact precautions, an intervention which is held as sacrosanct by many.
Even more recently, it was reported that heightened disinfection had no impact on hospital acquired C. difficile. Aggressive antibiotic(fluoroquinolone) restriction may be the way to go, however, this is not salvation.

These are troubling times in infection prevention as paradigms are challenged.

Until we have a better understanding of the extent to which C.difficile is both acquired and reliably prevented in the hospital, CMS should not penalize healthcare systems for C.difficile HAC measures.

How can we fairly penalize what we cannot (yet) reliably prevent?

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