Clostridium difficile Infections Are More Common In States With Fewer Hospitals Per Person

If they don't improve protocols, big hospitals could be putting thousands of lives at risk

Clostridium difficile colonies after 48 hours' growth

Credit: CDC via Wikimedia Commons

Every day, one in 25 hospital patients gets an infection just because they are in a hospital. One particularly nasty kind of bacteria is called Clostridium difficile, or C. diff. In some cases, it causes nothing more than a bad case of diarrhea. But for some, it can be deadly; 20 percent of the deaths caused by hospital infections can be directly traced to C. diff.

According to a report from the Centers of Disease Control and Prevention, the number of bacterial infections across the country decreased between 2011 and 2013, thanks to hospitals' efforts to control C. diff and other bacteria. California, Maryland, Rhode Island and Nevada are the only states where the infection rate was higher than the national average. These four states have some of the lowest ratios of hospitals to people, which means they are putting more people into fewer hospitals. An outbreak of a particularly strong strain of C. diff or lax hygiene regulations at even just a few of these hospitals could endanger thousands of lives.

Hospital patients are particularly vulnerable to infections; they often have weakened immune systems, and invasive procedures open the body up to microbes that can cause disease. Healthcare workers may transfer microbes between patients if they are not extremely diligent. So to combat the spread of disease, hospitals have adopted policies that enforce diligent hygiene habits for workers and tools alike—and for the most part, they've worked.

But C. diff is different because it is so opportunistic—and stubborn, says Melissa Brower, a spokesperson for the CDC. When a patient takes an antibiotic, the pill wipes out much of the bacteria in his intestines. That leaves space for C. diff to move in. "Healthcare workers are around all this stuff most of the time and it doesn't bother them," because they are not taking antibiotics, Brower says. Alcohol-based antibiotic hand sanitizers kill most bacteria, but C. diff is so hardy that only soap-and-water hand washing will do.

The bacteria spread through spores, and are constantly evolving into stronger strains, some of which are already resistant to antibiotics. That's probably why these states are having trouble, according to the California Department of Public Health. "Morbidity and mortality due to C. difficile infection have increased over the past several years due to the emergence of more infectious and more virulent C. difficile strains," spokesperson Corey Egel wrote in an email. If even a small step in the hospital's hygiene protocol isn't performed by all members of the hospital staff, the bacteria could persist there for years.

California is investigating why its infection rates are so high, and plans to implement new hygiene strategies to try to bring the numbers down. Emerging technologies may help these hospitals cut down on bacterial transmission by designing easy-clean medical tools or more effective hand sanitizers. But these technologies aren't ready for immediate use, so for now hospitals with high infection rates just have to pay more attention to hygiene protocols. Hopefully with more concerted efforts, healthcare professionals can keep C. diff at bay--and keep more people alive.