The mandatory requirement that Ontario hospitals report their C. difficile rates seems to have been followed by fewer such infections, a new study suggests.

C. difficile is the most frequent cause of infectious diarrhea in Canadian hospitals and long-term care facilities. Symptoms include watery diarrhea, fever, loss of appetite, nausea and abdominal pain or tenderness.

Prevention efforts at hospitals could be behind the reduction in C. difficile infection rates, Dr. Nick Daneman speculates. (Doug Nicholson/MediaSource)

In Tuesday's issue of PLoS Medicine, published by the Public Library of Science, researchers compared monthly rates of C. difficile infection at 180 Ontario hospitals between 2002 and 2010.

The province mandated the public reporting of monthly C. difficile rates starting in September 2008.

On average there were more than 5,000 cases of C. difficile per year.

The introduction of public reporting was associated with a nearly 27 per cent reduction in C. difficile, said lead author Dr. Nick Daneman of Toronto's Institute for Clinical Evaluative Sciences and his co-authors.

"Public reporting of hospital C. difficile rates was associated with a substantial reduction in the population burden of this infection," the researchers concluded, averting an estimated 1,900 cases a year.

How the improvements were accomplished is the focus of a future study.

"We can only speculate that focusing attention on it led to ramped up prevention efforts in hospitals and those could have included efforts to prevent transmission between patients or efforts to prevent susceptibility of patients by decreasing antibiotic use," said Daneman.

Antibiotic use

Rates of gastrointestinal infections acquired outside of hospital and urinary tract infections were unchanged.

Intriguingly, the researchers said, the apparent increase in C. difficile rates were also potentially explained by increases in the use of antibiotics in the population, a finding that lends support to "antibiotic stewardship" campaigns.

At an individual level, antibiotics are known to increase the risk of C. difficile infection.

The elderly, those with other illnesses or people taking chemotherapy are also at higher risk of infection.

Since the study was not a randomized trial, it's impossible to say for certain whether other factors that weren't taken into consideration, such as changes in the prevalence of certain strains of C. difficile, played a role in the reduction.

The researchers recognized the potential for "gaming" reported rates and used data that was independent of the public reporting system itself.

Starting in 2012, Ontario will link executive compensation at hospitals to achieving quality improvement targets, including those for C. difficile rates.

With files from the CBC's Amina Zafar