June 1, 2010 | American Society of Registered Nurses®
Journal of Nursing

Phoenix Area Hospitals Fight New Super Germ

PHOENIX, AZ (ASRN.ORG) --Maricopa County health officials have confirmed that a relatively new, extremely toxic strain of bacteria has been found in hospitals and other health-care facilities in the Valley.

The germ, known as Clostridium difficile, has long plagued the medical profession and is blamed for an increasing amount of illness in patients.

But this is the first time the new strain, known in medical circles as "NAP1," is believed to have been linked to patient illness and deaths in Arizona, health officials said. It carries at least 20 times as much toxin as the original strain.

According to the county, at least 10 patients have fallen severely ill from this new type of C. diff since early March. Two of those who were infected have died, though the germ has not been named conclusively as the cause of death. All the patients were elderly and suffered from health problems.

"Assuming this continues to evolve, it is going to be a real pain for our health-care communities," said Dr. Bob England, director of the Maricopa County Department of Public Health.

Like other "supergerms," all strains of C. diff are resistant to powerful antibiotics, and the infection is difficult and expensive to treat. The germ causes pronounced diarrhea and, in severe cases, can lead to inflammation of the colon, which can be fatal.

Healthy and younger people usually don't get C. diff. Most cases occur in health-care facilities, and those represent only a small fraction of the tens of millions of admissions to U.S. hospitals and nursing homes every year. But the number of cases has risen sharply over the past decade, to nearly 500,000 in 2007, according to the latest data from the U.S. Centers for Disease Control and Prevention.

The Arizona Republic first learned of an ongoing C. diff outbreak last month after filing a state Public Records Law request to obtain a health alert issued by the Arizona Department of Health Services.

The alert contained no information about how the outbreak started, which hospitals were involved or how many patients were affected. County officials maintained that they were not obligated to provide that information.

This week, officials with the county Public Health Department and Banner Health, a non-profit group, met with a reporter and an editor from The Republic. Banner revealed that Banner Baywood Medical Center in Mesa had identified the strain after seeing some patients become very ill.

The hospital alerted the county to the problem in early March.

"If there's a cluster, an outbreak, we want to report that," said Dr. John Hensing, executive vice president and chief medical officer at Banner Health, a Phoenix-based non-profit health-care group.

Banner officials say they believe that most, if not all, patients came to Banner Baywood with an active C. diff infection, rather than contracting it at the facility. Some arrived from long-term-care facilities and nursing homes or went to the emergency room after falling sick at home.

The patients were elderly, suffered from other health problems and had been on extensive antibiotics. Prolonged antibiotic use can heighten a patient's susceptibility to C. diff because the drugs can kill off the body's "good" bacteria, allowing it to flourish.

Arizona, like many other states, does not track incidences of C. diff.

But a Republic analysis of hospital-discharge records shows that from Jan. 1, 2008, to Dec. 31, 2009, patients at Arizona hospitals were identified as having a C. diff infections more than 15,400 times.

The bug is becoming a major problem for hospitals because it spreads easily. Traditional cleansers and hand sanitizers fail to neutralize its spores, which are often spread through fecal-oral contact. The best ways to deter C. diff is with bleach and aggressive hand-washing.

Banner said officials at Baywood took immediate steps to control the outbreak, including isolating patients who exhibited symptoms of illness.

They also sanitized surfaces and equipment throughout the hospital with bleach and instituted new hand-washing protocols for all patients, including those too sick to get out of bed.

Nurses now bring them bottles of water so they can scrub their hands with soap without getting up, officials said.

They believe they have the outbreak under control.

This is not the first time Banner Baywood has dealt with a spike in germ-related infections.

In April 2008, hospital officials noticed a spike among post-surgical patients. Nineteen cases involved a supergerm known as methicillin-resistant Staphylococcus aureus, or MRSA. Seven infections were tied to the E. coli bacterium, and about a dozen others were caused by various other bacteria, according to the hospital. The facility implemented a series of aggressive procedures over several months to eliminate the problem.

County public-health officials say it's likely that this strain will continue to crop up in community and health-care facilities.

Officials from the U.S. Centers for Disease Control and Prevention agree. The CDC said Tuesday that the NAP1 C. diff strain has been spreading rapidly since it was first identified in health-care settings in six states from 2000 to 2003.

It has now been officially identified in 39 states, although it's likely throughout the country, CDC officials said.

"Do I think it just got here? No. But this is the first time it was reported to public health," said Dr. Rebecca Sunenshine, medical epidemiologist for the county's Public Health Department. "So, I would start operating under the assumption that every strain we see is this new strain." 

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