Rates of C. difficile dropped by more than one quarter in Ontario after the province made it mandatory for hospitals to publicly report cases of the deadly hospital-acquired infection, according to a new study on the patient safety problem.
Researchers say the drop in rates suggest that public reporting helped to focus hospitals' attention on C. difficile, prompting them to find ways to prevent and reduce the spread of the infectious organism
Prior to September 2008 there were between 5,000 and 6,000 cases annually of C. difficile in Ontario.
After the province introduced mandatory reporting, rates fell by about 26 per cent, which translates to 1,970 fewer C. difficile cases per year, said Dr. Nick Daneman, the study's lead author and infectious disease specialist at Sunnybrook Health Sciences Centre.
"And since about 5 to 6 per cent of patients with C. difficile die directly from the C. difficile or in part from C. difficile, we also estimate this could mean more than 100 lives saved per year in Ontario," said Daneman, who is also an adjunct scientist at the Institute for Clinical Evaluative Sciences.
The study, published Tuesday in the journal PLoS Medicine, is the most rigourous study to date of public reporting on hospital-acquired infections.
Daneman said the results are not only statistically significant, but clinically significant because C. difficile is a common disease that can be fatal. He also said the organism is increasingly becoming more virulent.
Up until September 2008, only hospital administrators and infection control specialists knew the rates of hospital-acquired infections, including rates of C. difficile.
According to the Ministry of Health, there are currently four C. difficile outbreaks in Ontario hospitals, the most recent of which were declared July 5 at the Victoria site of London Health Sciences Centre and July 3 at Mississauga's Trillium Health Centre and The Credit Valley Hospital.
The public release of key hospital data followed a Star investigation into medical secrecy. There are currently nine patient safety indicators reported to the public, including hospital mortality rates and hand-hygiene compliance.
Clostridium difficile is one of the most common causes of infectious diarrhea in hospitals and long-term care facilities and the elderly and those with underlying health problems are most at risk. It has become a problem, in part, because of the over-use of antibiotics.
The study, which relied on an independent data source, found that prior to public reporting, rates of C. difficile increased between 2002 and 2008.
Daneman said the research does not pinpoint the specific mechanisms that reduced rates — that is the subject of further research — but he and his colleagues believe that publicly releasing infection rates motivated hospitals to better adhere to best practices in infection control. These include environmental cleaning practices, hand washing, isolating sick patients and increased surveillance for infection and outbreaks.
Health Minister Deb Matthews said she was pleased with the study's results.
"We know that when you measure and when you publicly report you can really drive change," she said. "People who work in health care really want to do what's best for patients and when they see that they can do better, how they stack up against other hospitals, they can improve their outcomes."
Dr. Michael Gardam, medical director of infection prevention and control at the University Health Network and Women's College Hospital, said
the study, along with anecdotal evidence, suggests that publicly releasing C. difficile rates has had a measurable impact. But he also warned that more needs to be done to control the infectious disease in the province.
Since April 2010, which is when the authors stopped analyzing data, Gardam said C. difficile rates have started to again rise.
"Public reporting has definitely done something, but it's not the only answer," he said.
The need for new hospitals —infection control is more difficult in older institutions — hospital overcrowding, and the continued miss-use of antibiotics continue to lead to C. difficile infections in Ontario, Gardam said.
