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Study provides new perspective on concept of HAIs
More than 80% of hospitalised patients who tested positive for Clostridium difficile were tested outside the hospital or within the first 72 hours of hospitalisation, suggesting that settings outside of the hospital may play key roles in the identification, onset and possible transmission of the disease, according to a new Kaiser Permanente study published today in the journal Mayo Clinic Proceedings.
The study provides new insight into the contagious and potentially deadly infection also known as C. diff, a bacterium most often associated with hospitals and other in-patient healthcare settings. It is one of the first to accurately identify a larger population of patients with C. diff by examining them in an outpatient setting as well as in the hospital and thus provides a different perspective on the concept of hospital acquired infections and how they may best be tackled.
"Kaiser Permanente's integrated healthcare system allowed us to track patients after they left the hospital in both the outpatient health setting and during a readmission, which contributed an important new perspective to the current C. diff story," says study lead author Sara Y. Tartof, PhD, of the Kaiser Permanente Southern California Department of Research & Evaluation. "Previous studies typically focused on diagnoses during a hospital stay, which tells only part of the story. These findings emphasise how important it is to test for the infection both in the hospital as well as in outpatient settings."
Researchers examined the electronic health records of more than 268,000 Kaiser Permanente patients in Southern California who were admitted to 14 Kaiser Permanente hospitals between 1st January, 2011 and 31st December, 2012. Of these patients, 4,286 - or 1.6% - tested positive for C. diff. Researchers also found that 49% of C. diff cases were acquired in the community or from an indeterminate source and that 31% of cases were associated with a previous hospitalisation.
"C. diff infection is a major public health concern in the U.S., with infection rates tripling over the last decade," says Sara Tartof. "This study's comprehensive view gives a more complete picture of the extent of healthcare associated infections."
According to the Centers for Disease Control and Prevention, C. diff is a bacterium that most often affects sicker, older adults who take antibiotics and causes a range of symptoms including diarrhea, fever, loss of appetite and inflammation of the colon. People can become infected with C. diff by touching items or surfaces that are contaminated with the bacteria or through physical contact with health care workers who have picked up the bacteria from surfaces or other patients.
The CDC reports that over the past several years, states have noted higher rates of C. diff infection and an associated increased risk of death. Studies also show that C. diff infection accounts for considerable increases in the length of hospital stays and more than $1.1 billion in healthcare costs each year in the US.
Michael Kanter, MD, regional medical director of quality and clinical analysis, Southern California Permanente Medical Group, says: "Kaiser Permanente works diligently to prevent C. diff infections in both the hospital and ambulatory settings. We promote judicious use of antibiotics, we make painstaking efforts to ensure our staff and healthcare providers practice hand hygiene, we prompt testing of symptomatic patients, and we conduct vigorous cleaning of rooms with special cleaning agents known to kill C. diff when patients with the infection are identified."
Kaiser Permanente can conduct transformational health research in part because it has what is believed to be the largest private patient-centered electronic health system in the world. The organisation's electronic health record system, Kaiser Permanente HealthConnect, securely connects approximately 9.3 million patients to 17,000 physicians in 618 medical offices and 38 hospitals. It also connects Kaiser Permanente's research scientists to one of the most extensive collections of longitudinal medical data available, facilitating studies and important medical discoveries that shape the future of health and care delivery for patients and the medical community.
Other authors of the paper include: Rong Wei, MA, Hung Fu Tseng, PhD, and Steven J. Jacobsen, MD, PhD, Kaiser Permanente Southern California, Department of Research & Evaluation; Kalvin C. Yu, MD, Kaiser Permanente West Los Angeles Medical Center, Department of Infectious Diseases; and Gunter K. Rieg, MD, Kaiser Permanente South Bay Medical Center, Department of Infectious Diseases.
24th July 2014