Combatting Recurrent C diff and Other HAIs Through Research, Best Practices, and Clinical Innovation

“The research that we’re doing, thanks to AHRQ’s support, is making it easier for clinicians to apply best practices and improve care for patients who suffer from dangerous infections.”

Encouraging clinicians to follow practices to reduce healthcare-associated infections (HAIs) and studying how to prevent their recurrence are hallmarks of the work that infectious disease specialist Nasia Safdar, M.D., Ph.D., conducts with AHRQ funding. 

The medical director of infection control at the University of Wisconsin (UW) Hospitals and Clinics, Dr. Safdar has conducted several AHRQ-funded studies focused on preventing or treating Clostridium difficile infection, often referred to as C diff, which is a gut infection that affects up to 500,000 Americans and is responsible for about 20,000 deaths per year. It is commonly associated with prolonged antibiotic use.

Using a systems engineering framework, Dr. Safdar and colleagues conducted an AHRQ-funded study to identify factors that affect health care workers’ use of prevention activities, known as bundles, to combat C diff.  Knowing the factors that facilitate—or are barriers to—the use of these practices can help clinical teams better understand how to standardize their efforts to prevent infection.

Helping health care workers understand how to prevent and treat C diff is just one piece of the puzzle, however. Patients who develop C diff often develop the infection again, so it is also important to find ways to prevent this recurrence. That’s why AHRQ recently funded Dr. Safdar to conduct a large randomized controlled trial to determine if giving a preventive antibiotic to patients who have recurrent bouts of C diff can rid them of the infection for good. Knowing that antibiotic resistance could be a potential downside to this treatment, Dr. Safdar is also looking at whether the treatment is worth the potential risk of resistance. 

Antibiotics may be effective to prevent recurrent C diff, but other tactics could also be helpful. For this reason, Dr. Safdar is conducting a small AHRQ-funded pilot project ending in 2018 that seeks to determine if using a fecal microbiota transplantation (FMT) at the same time as antibiotics can restore health to patients who have recurrent C diff.  FMT involves transferring beneficial fecal bacteria from a healthy individual to a person whose beneficial gut bacteria has been depleted.

Successfully preventing HAIs means that antibiotics don’t need to be prescribed as frequently, reducing the risk of antibiotic resistance and infections such as C diff.  Previous research has shown that infections among patients in intensive care units can be prevented by bathing them in a special antiseptic. Dr. Safdar is using systems engineering principles in a large, 3-year AHRQ-funded study to determine the best ways to implement this proven protocol in a variety of settings.

In addition to her research work, Dr. Safdar led UW’s adoption of the Comprehensive Unit-Based Safety Program, or CUSP.  The program is an evidence-based method that uses a structured framework for safety improvement. "CUSP provided a systematic approach for all of our efforts, which led to much more favorable outcomes," she said.  These efforts helped UW receive the 2013 Partnership in Prevention award from the U.S. Department of Health and Human Services, the Association for Professionals in Infection Control, and the Society for Healthcare Epidemiology of America.

Principal Investigator: Nasia Safdar, M.D., Ph.D., Vice Chair for Research, Associate Professor, Department of Medicine
Institution: University of Wisconsin-Madison
Grantee Since: 2015
Type of Grant: Various

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