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Objective: Compare the rate of HA-CDI on hospital units with and without Clean Team (CT), an enhanced frequently-touched (FT) surfaces disinfection program. Determine CT impact on patient satisfaction, hospital costs and length of stay (LOS). Measure overall impact of a C. difficile prevention program at a large urban teaching hospital.
Methods: CT staff disinfected FT surfaces twice daily in patient rooms on five acute care units during the six month study period. Supervisors determined cleaning performance in randomly selected rooms daily using a real-time assay to measure organic material on FT surfaces; immediate feedback was given to CT staff. HA-CDI was measured on five CT and 16 control units during a 12 month baseline and six month study period; HA-CDI was defined as a positive assay for C. difficile toxin obtained > 72 hours after hospital admission. Patients with a positive assay in the prior 8 weeks were excluded. HA-CDI cases were assigned to the patient’s unit location 72 hours prior to assay. Patients admitted to the study unit > 3 days after initial hospital admission were excluded. Our Antibiotic Stewardship Program focuses on reducing flouroquinolone use and ensuring appropriate duration of therapy by review at 96 hours. Antibiotic utilization on study units was measured. Patient satisfaction was measured by anonymous post-discharge survey. Impact of HA-CDI on LOS was determined by DRG analysis of hospital data; $600 variable direct cost per day assumed.
Results: The HA-CDI rate (per 1000 pt-days) on all units decreased from 1.06 during baseline to 0.76 during the study period. The HA-CDI rate during the baseline and study periods was 1.28 and 0.66 on CT units and 0.94 and 0.82 on control units, respectively (p=0.05). Flouroquinolone use (measured as day of therapy per 1000 pt-days) on all units decreased from 86 during baseline to 64 during the study period (p<0.05). Clindamycin, carbapenem and 2/3 generation cephalosporin use was unchanged. Patients stating their room was “always” clean increased from 56% to 60% on CT units and decreased from 55% to 54% on control units during the intervention period. LOS in HA-CDI cases increased by a mean of 7.8 and a median of 10.2 days; additional direct costs per HA-CDI were $4,860–$6,120. Implementing CT in our hospital may avert approximately 85 cases of HA-CDI annually, resulting in an estimated annual saving of $413,000 in direct hospital costs.
Conclusions: HA-CDI decreased overall during the study period. Reduction in HA-CDI and increase in patient satisfaction was greater on Clean Team units compared to control units. A comprehensive C. difficile prevention program may result in significant cost savings.