Clostridium difficile Not A Medical Error?


According to this article in American Medical News, researchers at McGill University in Montreal discovered that less than half of 836 patients with Clostridium difficile infections had been exposed to antibiotics in the 45 days prior to their hospitalizations. The study is in CMAJ, but the link isn’t working at the time of this post. The study also showed that, just like MRSA, the rate of community-acquired Clostridium difficile is rising. The rate per 100,000 person-years among people 65 and older in Quebec rose from 0.5 in 1997 to 57.2 in 2004.

If Clostridium difficile infections occur more than half the time without any preceding antibiotic therapy, what exactly is the “error” that needs to be corrected to cease the occurrence of this “never event”?

“Never events” aren’t about patient safety. Never events aren’t about evidence-based medicine.

Never events are all about the Benjamins.

The joke’s on CMS, though. Now we’re going to spend so much money testing hospitalized patients for “C. diff” that the money CMS saves by not paying for the few positive instances of this “never event” will pale in comparison.

The link to the CMAJ article is here. Commentary about the article is here.
Factiods from these two articles include:

  • C. difficile can be “cultured from the stool of 3% of healthy adults and up to 80% of healthy newborns and infants.” Is the birth of a health child with C. difficile in its colon the next “never event”? Will all healthy newborns be given Flagyl and Vancomycin to eradicate these organisms?
  • Admitted patients may have C. difficile, but will not all have symptoms of C. difficile-associated diarrhea during their hospital stay. In other words, people might have C. diff prior to admission, but might not develop symptoms until after they’re hospitalized. Hospital gets dinged for an “error” that wasn’t its fault.
  • In addition to antibiotic use, C. difficile is also associated with use of a proton pump inhibitor, presence of inflammatory bowel disease, presence of irritable bowel syndrome, and presence of renal failure. What are we going to do with people who take Prilosec and have Crohn’s disease? Refuse to admit them to avoid the “never event”?


  1. I work at a brand new hospital that just opened 2.5 weeks ago, and we have had 2 pts already with C-diff in 2 seperate rooms…in which they were the first patients ever to occupy those rooms.

    So would of hospital get “dinged” as a “never event” still, even though there is no way we could of given it to them? That is simply crazy! Grrrr….gotta just love our gov’t!

  2. anonymous nurse on

    C. diff can also be associated with chemo. Have seen a pt develop c diff diarrhea followed by acute abdomen and ultimate demise after palliative chemo for his end stage lung CA. No abx preceeded his chemo tx.

    Never events are ridiculous.

  3. It continues to amaze me that people do not understand the scientific method. People continue to make illogical decisions based on simple coincidence.

    But when you point out the illogical fallacy to them, they get mad at you. Either that or they create another fallacy that isn’t as amenable to inspection.

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