Main Menu Browse by Day or Program Author Keywords

160 Contact Isolation is No Longer Enough to Control C. difficile

Saturday, April 2, 2011
Trinity Ballroom (Hilton Anatole)
Ryan Blanton, MS, MT, CIC , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Sylvia Pegg, RN, BSN, CIC , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Samantha Davies, BHA, MLT , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Camp Jacquie, RN, BSN, CIC , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Cindy Adkins, RN, CIC , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Robert Sherertz, MD , Wake Forest University Baptist Medical Center, Winston-Salem, NC
Background: In the last decade the epidemiology of Clostridium difficile has been rapidly changing with the emergence of new virulent strains and an overall increase in incidence and mortality worldwide.  Between February-April 2010 (outbreak period), our institution had an increase in healthcare associated C. difficile cases; such that, we investigated the effect of more intensive control methods on the incidence of C. difficile.

Objective: This study was designed to evaluate the impact of more intensive C. difficile interventions on the overall incidence rate of C. difficile infections at our institution. 

Methods: Using the CDC/SHEA C. difficile infection surveillance definitions, each positive toxin A/B result by enzyme immunoassay (TECHLAB®, C. DIFFICILE TOX A/B II™) was classified as HA or CA beginning one year prior to the outbreak period.  Interventions were initiated including immediate notification of C. difficile positivity to responsible healthcare providers, education for all internal stakeholders (nursing and housekeeping staff), daily bleach cleaning of rooms for C. difficile infected patients, and thorough (terminal room clean) bleach cleaning of all rooms where patients with C. difficile residing during the outbreak period.   

Results: During the 13-month period before our suspected outbreak, the rate of HA C. difficile was 5.7 per 10,000 patient days(135/235,275).  During the outbreak period the rate increased to 8.0 (45/56,382; P<0.000002).  In the  5-month period after the  interventions began, the rate decreased significantly to 5.0 (49/ 97,684; P=0.03).    Interestingly, the rate in one of the months following interventions was 7.7, which we concluded was due to the housekeeping staff not using bleach cleaning as a result of patient and nurse complaints.  There were no documented adverse reactions to the bleach, only an inconvenient smell. Once bleach cleanings were re-initiated, the rate fell back to 3.1. 

Conclusions: During a C. difficile outbreak, it was clear that the best practice guidelines for controlling C. difficile were effective. Our ability to immediately notify healthcare personnel due to a recently implemented automated notification system may have also contributed to the improvement.