Researchers Receive Grant to Reduce Deadly Diarrhea in Rochester-area Nursing Homes

May. 6, 2014
State Awards $950,000 to Combat C. Diff

Researchers at the University of Rochester Medical Center received $950,000 from the New York State Department of Health to work on reducing Clostridium difficile or C. diff in Rochester-area nursing homes over the next five years. Preventing C. diff – a bacterial infection that can cause life-threatening diarrhea and inflammation of the colon – in healthcare facilities is a top priority of the U.S. Department of Health and Human Services as it looks to cut the country’s sky-high healthcare costs.

The research team, led by Ghinwa Dumyati, M.D., director of the communicable diseases surveillance and prevention program at URMC’s Center for Community Health, is focusing on nursing homes because C. diff is more common in the elderly. Taking antibiotics is another major risk factor and local data shows that close to 90 percent of Monroe County nursing home residents who acquired C. diff had received antibiotics in the previous 12 weeks.

“The incidence of C. diff is much higher in the elderly because their immune systems are often compromised due to disease or old age,” said Dumyati, an associate professor of Infectious Diseases who treats patients at UR Medicine’s Strong Memorial Hospital. “Add in antibiotics, which kill bacteria in the gut that keep C. diff in check, and the infection flourishes.”

The incidence of C. diff is much higher in the elderly because their immune systems are often compromised due to disease or old age.

A major goal of the new project is to reduce the burden of C. diff in nursing homes by decreasing inappropriate use of antibiotics. 

Dumyati’s team will collect data on antibiotic usage in nursing homes to identify potential interventions to improve the use of the drugs and collaborate with medical directors at the homes to develop antimicrobial usage guidelines and education materials. Materials will be geared towards healthcare professionals as well as patients and family members, as it is important to educate them that antibiotics are not always needed.   

Research shows that the majority of patients who develop C. diff in nursing homes had a recent hospitalization, so antibiotic use in patients entering nursing homes from hospitals must be carefully reviewed. 

Ghinwa Dumyati, M.D.

“When a patient moves from the hospital to a nursing home on an antibiotic, it may not be clear how much longer is needed in the course of therapy.  Improving communications at the time of transition is just one way to avoid unnecessary days of antibiotic therapy,” said Elizabeth S. Dodds Ashley, Pharm.D., associate director of Clinical Pharmacy Services at UR Medicine’s Strong Memorial Hospital who will co-lead the project with Dumyati. “One way to combat this overprescribing of antibiotics could be to institute a mandatory hand-off call to review discharge instructions and discuss if the antibiotic is still needed and for how long.”

“We want to learn what we can do at the hospital to enhance our communication and coordination with physicians and pharmacists at nursing homes,” added Dumyati. “What we are doing is completely new in the Rochester area and we would like to investigate if this could be done on a large scale.”

Dumyati says that the project is similar to other projects to prevent patient readmissions to the hospital by orchestrating better communication between the hospital and outpatient service providers, such as primary care physicians, physical therapists, social workers and pharmacists.

Dumyati already leads the Rochester Patient Safety Collaborative, a citywide effort to fight C. diff at four Rochester hospitals. The project is supported by the hospital CEOs and safety experts from Excellus.

Though there are approximately 35 nursing homes in Rochester, the new project will focus on the bigger homes that receive the most patient transfers from area hospitals.