Valley Hospital in Ridgewood has reduced the incidence of the hospital-acquired infection clostridium difficile, or C.diff, through an intervention that might seem a bit paradoxical: limiting the prescribing of antibiotics to hospital patients.
“The over-use of antibiotics predispose people to infection with C.diff,” which is an antibiotic-resistant bacteria, explained Dr. Neil Gaffin, an infectious disease specialist at Valley. The theory, Gaffin said, is that the broad-spectrum antibiotics typically administered in hospitals and other health care facilities “kill all the healthy flora in your gut, and if you happen to harbor or acquire C.diff, it sets the stage for C.diff to proliferate.”
Gaffin said C.diff “is a very nasty bacteria that wreaks havoc on the frail and elderly.”
Valley launched its antibiotic stewardship program in March 2013. At first, the hospital pharmacy limited antibiotic prescriptions to four days. At that point, the patient was evaluated and the physician could continue the antibiotic if necessary.
Gaffin said that, by putting a time limit on the prescription, “It now makes the physicians consider: Does the patient still need the antibiotic?” In late 2013, the hospital further tightened its guidelines so antibiotic prescriptions are reviewed after 48 hours.
“What we have shown is that, when you control antibiotics, when you really limit their use to only those situations where it is felt to be really needed; then you can reduce the driving force for C.diff to flourish in the hospital,” Gaffin said.
He said the hospital has not seen adverse patient outcomes after antibiotics were curtailed: “What we found is that a lot of the antibiotics were not necessary.”
An article by Gaffin on Valley’s antibiotic stewardship program will be published in an upcoming issue of the journal Clinical Infectious Diseases.
Gaffin said the hospital’s antibiotics program is coupled with a comprehensive program of hand-washing and disinfecting of the hospital environment that together have reduced the incidence of C.diff.
Getting physicians on board was critical to the program’s success, Gaffin said. Initially, the program was greeted with some skepticism, but as C.diff cases declined, “The physicians have by and large bought into this, and that is a huge thing.”
In making the case to the physicians, a key argument was the unique impact that antibiotics have on the overall health of the hospital environment, Gaffin explained.
“Antibiotics are the only class of drugs whose use affects everyone” in the hospital, Gaffin said. “When you adopt the mindset that antibiotic use affects everyone, it makes sense.”
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