Sustained elimination of Clostridium difficile infection

Background:   We have previously shown that daily cleaning of patient rooms with bleach wipes containing 6.15% sodium hypochlorite on high incidence units for Clostridium difficile infection (CDI) can effectively reduce rates in the short term. Whether such an intervention can be sustained with continued reductions in CDI was unknown.

Objective:

1. Reduce hospital-acquired Clostridium difficile infections (CDI) on 2 high risk units.
2. Increase the number of days between hospital-acquired cases of C.
diff infection.
3. Ensure all rooms are cleaned using bleach wipes daily.
4. Monitor average monthly isolation compliance.

Methods: We conducted surveillance for hospital acquired CDI before and for 1 year after the introduction of daily cleaning of rooms with bleach wipes on two previously identified high incidence units. Hand hygiene on these units was performed with alcohol based hand rub regardless of C.
difficile status. Contact isolation was maintained throughout hospitalization. Incidence rates of C. difficile infection were recorded for units A and B for a year prior to and one year following the change in environmental cleaning from a quaternary ammonium compound to Clorox germicidal bleach wipes 6.15% - 5200 ppm active chlorine. Daily and terminal cleaning of all rooms began in August 2009 and continues. Data is presented for one year of cleaning. Strict isolation compliance was recorded by a standardized observation method before and throughout the intervention. Rates of overall and hospital-acquired CDI incidence, time between hospital acquired cases and compliance with isolation was recorded throughout the study period. 

Results: Incidence of Hospital-acquired CDI

Rate of CDI prior to Intervention          Rate of CDI over 1 year of intervention

            18.4/10,000 pt days                             3.3/10,000 pt-days

Number of Days between Hospital Acquired CDI Cases

            Prior to Intervention - 13          over 1 year of intervention - 104

Percentage of Rooms “Clean” by Clean Trace testing

            Prior to Intervention                  over 1 year of intervention

                      100%                                       100%

  Contact Isolation Compliance

              Prior to Intervention                  over 1 year of intervention

                       80%                                         90% 

Conclusions: Daily room cleaning with germicidal bleach wipes can lead to sustained reductions of CDI in hospital units with a high incidence of C. difficile. These reductions can be accomplished without a change in hand hygiene from alcohol-based hand rubs to soap and water.