Efficacy of a Targeted Bleach Cleaning Intervention to Reduce the Incidence of Endemic Clostridium difficile-Associated Diarrhea in a Multi-Hospital Healthcare System

Background: Clostridium difficile is the most common cause of hospital-associated diarrhea. Contaminated hospital surfaces are a major source of transmission. Effective eradication of C. difficile spores from the hospital environment is one of the key interventions in controlling transmission.

Objective: The purpose of this study was to evaluate the effectiveness of a targeted environmental cleaning program using a bleach-based decontamination regimen in reducing the incidence of healthcare-associated Clostridium difficile colitis in a large multi-hospital healthcare system.

Methods: An infection control intervention which involved using a 1:10 dilution of bleach solution to clean all rooms of patients in contact isolation began at Good Samaritan and Bethesda North hospitals in early April 2007. The rate of new onset healthcare-associated Clostridium difficile-associated diarrhea per 1,000 patient days was followed before the bleach cleaning intervention (April 1, 2006 – March 31, 2007) and after the intervention (April 1, 2007 – March 31, 2008). 

Results: During the full year periods, there was no significant difference in the rate of new onset healthcare-associated Clostridium difficile-associated diarrhea between the pre-intervention and post-intervention periods at either hospital. However, during the flu season months (October – March), rates per 1,000 patient days decreased significantly at Bethesda North from pre intervention (0.86) to post intervention (0.51) (P = 0.03). Multiple regression showed that after controlling for age and the usage of antibiotics and proton-pump inhibitors, rates were still significantly different between pre and post intervention periods at Bethesda North during the flu season (P=0.01). There was no significant effect during the flu season months at Good Samaritan Hospital. When comparing flu season and non flu season, antibiotic usage was significantly greater during the flu season at Bethesda North (P<0.01), but there was no significant difference at Good Samaritan Hospital.

Conclusions:

The study results indicate that a bleach cleaning intervention program may significantly reduce the incidence of new onset healthcare-associated Clostridium difficile-associated diarrhea during the flu season, when antibiotic use in the hospital is highest.