WIHI: All Hands on Deck to Reduce C. Difficile

Date: April 9, 2015


  • Dale Gerding, MD, Professor of Medicine, Loyola University Chicago Stritch School of Medicine; Research Physician, Edward Hines Jr. VA Hospital
  • Jason Leitch, PhD, MPH, National Clinical Director, Healthcare Quality, Scottish Government
  • Alan Whippy, MD, Medical Director of Quality and Patient Safety, Permanente Medical Group, Northern California
  • Don Goldmann, MD, Chief Medical and Scientific Officer, Institute for Healthcare Improvement
What was your reaction when you heard the news that Clostridium difficile (C. diff) infected far more people in 2011 than first reported by the US Centers for Disease Control and Prevention (CDC)? Writing in the New England Journal of Medicine at the end of February, the CDC updated its own prior calculations to report that the burden of infection in 2011 was 80% higher than previously stated. In total an estimated 453,000 people were afflicted with C. diff in 2011; C. diff was a factor in some 29,000 deaths.
Our reaction here was, among other things, to schedule a WIHI and to touch down with some people who can help us make sense of the numbers and the health care and community settings contributing to them. And, more importantly, to check in on where progress is being made to reduce instances of C. diff and where much more aggressive work needs to be done. While there are indications that hospital-onset C. diff is declining in the US, no one is satisfied with the pace of change.
WIHI host Madge Kaplan assembled a solid panel to discuss the issues. Dale Gerding walks us through the latest epidemiological research on C. diff, proven reduction strategies, ongoing challenges with antibiotic stewardship, and where trend lines are moving in the right direction. Jason Leitch gives us the view from the UK, and Scotland in particular, where concerted interventions have led to an 82% decline in cases of C. diff in hospitals among people over 65. Alan Whippy tells us about important work at Kaiser Permanente, where significant progress has been made, too, and adherence to best practices is crucial so problems can't creep back in. And, IHI's Don Goldmann helps us appreciate why it's important to stay focused on acute care settings, even as we grow appreciate the value of prevention and detection of C. diff across the continuum of care and the community.
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