Nearly 27% reduction of C. difficile after public reporting introduced: study

Mandatory public reporting on hospital Clostridium difficile (C. difficile) rates, introduced in September 2008, was associated with a 26.7 per cent reduction in this hospital-acquired infection in Ontario, according to researchers at the Institute for Clinical Evaluative Sciences (ICES).

“Hospital public reporting may be an important potential means to reduce rates of this burdensome infection,” says lead author Dr. Nick Daneman, an adjunct scientist at ICES.

C. difficile is the most frequent cause of infectious diarrhea in Canadian hospitals and long-term care facilities. The elderly and those with other illnesses or who are taking antibiotics or cancer chemotherapy are at greatest risk of infection. Symptoms include watery diarrhea, fever, loss of appetite, nausea and abdominal pain/tenderness. In some circumstances, C. difficile infection can be fatal.

The past decade has witnessed a remarkable global surge in the incidence and severity of C. difficile. The majority of infections are acquired in hospitals. C. difficile is now a leading contributor to infectious diseases morbidity and mortality in developed countries.

This longitudinal population-based cohort study performed in Ontario between 2002 and 2010 found:

• On average there were more than 5,000 cases of C.difficile per year in Ontario.
• C. difficile rates increased between 2002 and 2008 prior to public reporting.
• The introduction of public reporting in September 2008 was associated with a 26.7 per cent reduction in C.difficile.
• This translates to 1,970 fewer C. difficile cases per year with an estimated 100 fewer deaths.  

“This is the most rigorous study to evaluate the impact of public reporting on hospital acquired infections and supports the Ontario Ministry of Health and Long-Term Care’s decision to mandate reporting of this patient safety problem,” says Daneman. “We speculate that focusing the public lens on C.difficile helped to identify this pathogen as a major patient safety concern, and influenced hospitals to ramp up prevention efforts. The direct mechanisms by which these improvements were accomplished will be the focus of further study.”

The study “Reduction in C.difficile Infection Rates After Mandatory Hospital Public Reporting: Findings From a Longitudinal Cohort Study in Canada” is in the current issue of PLoS Medicine.

Authors: Nick Daneman, Therese A Stukel, Xiaomu Ma, Marian Vermeulen, Astrid Guttmann.

ICES is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy.

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