New clinic at Mayo focuses on C. diff treatment and research
■ At the same time, a study shows that systematic cleaning techniques and better monitoring can help reduce such infections.
By Tanya Albert Henry — Posted July 8, 2013
With Clostridium difficile infections becoming more severe and harder to treat, Mayo Clinic has opened a new clinic dedicated to the infections that annually kill more than 7,000 people and send about 336,000 to hospitals.
The C. difficile Clinic in Rochester, Minn., will serve a range of patients, including those who have the infection for the first time, patients who have recurring and relapsing infections, and people who have infections that have not responded to conventional therapies.
Research, too, will be a part of the clinic's mission. Patients will be offered opportunities to participate in clinical trials for their treatment, and the clinic will participate in research studies of the gut microflora in collaboration with Mayo Clinic's Center for Individualized Medicine.
“A clinic that is dedicated to the management of these patients that is staffed by experienced physicians and a whole team of study coordinators, nurses and researchers in the microbiome field who have a vested interest in C. diff will help improve patient outcomes,” said Mayo Clinic gastroenterologist Dr. Sahil Khanna. Dr. Khanna will staff the clinic with gastroenterologist Darrell Pardi, MD.
C. diff infections often occur after antibiotic treatments destroy the healthy bacteria in the digestive tract. A 2012 Centers for Disease Control and Prevention study found that 94% of such infections in 2010 were associated with receiving health care. Of the cases studied, 25% of the infections were among patients who had been in the hospital. The remaining 75% of people first showed symptoms in nursing homes or after receiving care at a doctor's office or clinic.
As many as 5% of patients who get the C. diff infection have multiple recurrences because their bodies cannot restore the gut flora, Dr. Khanna said. The clinic's health care professionals can help patients restore the gut flora through a fecal transplant, in which donor stools from a healthy person are placed in the patient with the infection.
“We believe this can disrupt the cycle of recurrences and restore the healthy microbiome and healthy bacteria within the gut,” Dr. Khanna said.
Disinfecting rooms is key
Meanwhile, recent studies show that hospitals that take extra steps to clean and disinfect rooms have been able to reduce the number of C. diff infections.
The presence of C. diff after a room was cleaned at the Louis Stokes Cleveland Veterans Affairs Medical Center dropped to 7%, down from 67%, when a team of three housekeepers disinfected high-touch surfaces using bleach germicidal wipes. A supervisor then took ATP bioluminescence readings from the bed rail and table, call button and telephone, and toilet seat and bathroom handrail to make sure the room was disinfected.
The study, published in the May issue of Infection Control & Hospital Epidemiology, found that two other ways of cleaning helped reduce the presence of C. diff, but not as dramatically. During one period of the 21-month study, the hospital educated the cleaning staff about C. diff and applied fluorescent marker to 14 high-touch surfaces in patient rooms. The thoroughness of the cleaning was assessed based on the marker being removed. This way of cleaning reduced positive cultures to 57%. When an automated ultraviolet radiation device was added to the process, positive C. diff cultures dropped to 35%.
“Health care facilities are increasingly turning to automated room disinfection devices as a strategy to optimize environmental disinfection,” said study author and internist Curtis Donskey, MD, a staff physician at the VA medical center. “With effective monitoring and feedback, motivated environmental services personnel can achieve results that rival or surpass many of the automated devices.”
Rhode Island Hospital used a multidisciplinary approach to reduce its C. diff infections by 70% and decrease deaths from hospital-associated C. diff by 64%, according to a study in the July issue of The Joint Commission Journal on Quality and Patient Safety. The hospital more closely monitored patients determined to be at higher at risk for infection, developed a containment plan, improved the sensitivity for the test to detect the toxin in stool specimens and enhanced how patient rooms and equipment were cleaned.
“We were able to significantly reduce the risk of this virulent infection and ultimately provide better, safer patient care,” said Leonard Mermel, DO, the study's principal investigator and medical director of the hospital's Dept. of Epidemiology and Infection Control.