A Targeted Strategy to Wipe Out C. difficile

Background: Based upon prior surveillance we identified units with high endemic rates of C. difficile infection. As part of a strategy to reduce healthcare associated CDI we targeted two units with high colonization pressure for a single focused intervention - daily and terminal cleaning of all patient rooms with Clorox ultra germicidal bleach wipes containing 6.15% sodium hypochlorite.

Objective:

1.        Reduce hospital acquired C. difficile infection rates on 2 very high risk units by 30%
2.        Increase the interval between hospital acquired cases of C. difficile to >20 days.

3.     Insure all rooms on high risk units are effectively cleaned using Clean Trace technology

Methods: Controlled Before and after study.
Incidence rates of C. difficile infection were recorded for units A and B for the quarter year and entire year prior to initiation of the change in environmental cleaning from a quarternary ammonium compound to the new bleach product. Environmental services personnel were trained to use Clorox ultra germicidal bleach wipes 6.15% - 5200 ppm active chlorine, for daily and terminal cleaning of all rooms on these two contiguous units beginning in August 2009. Cleaning of rooms was assessed by supervisors and via use of Clean Trace technology on a random sample of rooms before and during the intervention. Surveys were obtained to assess satisfaction and tolerance from patients and ES employees before and during the intervention. Strict isolation compliance was recorded by a standardized observation method before and during the intervention. Infection prevention and control monitored overall CDI incidence, healthcare acquired CDI incidence, compliance with the interventions, and satisfaction surveys of patients, staff and ES employees. 
Results: Incidence of healthcare acquired CDI
                                Before                     After                 

Reduce hospital-acquired Clostridium difficile infections (CDI) on Units A and B

18.4 (healthcare acquired CDl infections per 10,000 patient days)

3.7

 Time between healthcare acquired cases of CDI 

Increase the number of days between hospital-acquired cases of C. diff infection incidence on units

13 days

74 days

 As of Nov. 2009 intervention unit A has gone 137 days and B has gone 74 days without HCA C. diff infection
 Isolation Compliance

Monthly monitoring of strict isolation compliance

1st qtr A 80% B 70%

A 80% B 97%

 Room cleaning by Clean Trace technology

All patient rooms are cleaned using Germicidal bleach wipes daily and at terminal dismissal standards by Environmental Services

100% of rooms 5 rooms audited using Clean Trace audits met  standard of 90% of swabs will have readings of < 250 RLU.

100%  of rooms (5) had a 100% pass rate

 Patients tolerated the cleaning with no concerns. ES Employees initially had concerns regarding odor and irritation but these were resolved.

Conclusions: Ultra germicidal bleach wipes were well tolerated by patients and effectively reduced the incidence and time between cases of healthcare acquired Clostridium difficile infections on a high incidence medical unit.