Ohio Hospital Association Learning from Patient Stories June 15, 2017

The Stakes…

Who Was Peggy?

Peggy’s C. diff Story Broad spectrum antibiotic following root canal Symptoms begin 5 days into course Suspected stomach virus Admitted to hospital 5 days after diarrhea onset Died 36 hours later

Lessons from Peggy’s Story Lack of C. diff Awareness Persistence of C. diff Myths Antibiotic Overuse (Prophylaxis) No warning from dentist Danger of Prescribing Imodium

Learning from Patient Stories With C. diff changing, patient experiences: Humanizes statistics Breaks through C. diff mythology Illustrates challenges and opportunities in infection control, prevention, public education, transparency and treatments Highlights opportunities for collaboration

Apryl Gleespen Healthy 59 year-old from Akron with recurrent UTIs Given 3 different antibiotics in a 2-month span Failed Flagyl and Vanco, surgery was suggested Saved by fecal transplant via nasal-gastric tube Lessons Polypharmacy can occur with antibiotics Current treatments remain insufficient for some patients

Andi L. 4 year-old from Zanesville started with vomiting and diarrhea No recent antibiotics usage Pediatrician initially dismissed C. diff due to age Multiple courses of flagyl eventually resolved infection Lessons Every year, 17,000 children get C. diff infections in the US CDI can occur without recent antibiotic usage

MaryAnn Dillon ER Nurse for 25 years Atypical C. diff presentation Worked with Peggy’s sister Peggy’s story was impetus for MaryAnn to request C. diff test C. diff cost her 3 months of work Lessons Healthcare Workers are at risk Personal stories resonate

PLF’s Work Awareness Raising & Education Advocate Training C. diff Stories PSA, Website and Social Media Hospitals, QIOs, Agencies Advocate Training Amplifying Our Work Locally HAI Committees, Hospitals, Media Policy Advocacy Increased Funding for ARO Increased Surveillance/Reporting

Moving Past Blame… Cycle of Blame Doctors Administration Nurses Janitorial Patients Cycle of Blame

C. diff is changing 1 patient with C. diff dies every 5 minutes 5 patients are diagnosed with C. diff every minute Infections rates have doubled since 2001 10% of patients colonized at admission 50% of cases are community-acquired Strains increasingly virulent and deadly Previously, low-risk populations (post-partum women, children, etc.) are getting C. diff CDC now classifies C. diff as an “urgent threat”

29,000 deaths according to CDC Tip of the Iceberg 29,000 deaths according to CDC 109,000 deaths 2008 Prevalence Study Nursing Home Deaths (Unreported) Community Deaths

We have the knowledge & technology… We know how to minimize transmission in hospitals High degree of hand washing and sanitation compliance Vigorous environmental cleaning coordinated with Infection Control Active detection and isolation of suspected carriers Antibiotic stewardship Education of patients and visitors New technologies from more sensitive tests to UV cleaning technologies are emerging regularly Too often the missing ingredient is the will to change

All Hands on Deck! C. diff is a complicated public health issue with several direct and indirect causes It requires nuanced, manifold approaches Intra-hospital and inter-facility Public awareness Treatment and prevention development We all have a role to play

Working Together Doctors, Nurses & other Healthcare Workers Patients & Advocates Healthcare Administrators Policymakers Clostridium difficile

“All you have in this world is each other.”

A World Where C. diff is Rare, Treatable & Survivable. Peggy’s Vision A World Where C. diff is Rare, Treatable & Survivable.