Abstract
The incidence of Clostridium difficile infection (CDI) in the UK rose dramatically during the early years of this century, in part associated with the emergence of the hyper-virulent ribotype 027 strain. The University Hospitals of Leicester (UHL), a 2000-bed acute UK NHS Trust, implemented a number of interventions, which led to an 80% reduction in new cases over a twelve month period. Changes were introduced as a result of collaboration between the Infection Prevention team, the departments of Microbiology and Infectious Diseases, and with the support of the Trust Executive. These strategies are described in detail and included; implementation of antimicrobial stewardship, specific hygiene and cleaning measures, the introduction of a care pathway form for all infected patients, the opening of an isolation ward for patients with CDI, strengthened organisation and clinical management, and rigorous attention to education within the Trust. The implementations described are of continued relevance in the face of new infection challenges, such as the increasing incidence of multi-drug resistant organisms.
Highlights
IntroductionClinicians in the UK, and elsewhere in Northern Europe and North America, noticed a rise in mortality and other complications associated with the disease [2,3,4]
The peak incidence of Clostridium difficile infection (CDI) within the Trust occurred in May
This paper describes the multi-interventional approach taken by one UK Teaching NHS Trust in response to the international epidemic of CDI, which peaked in 2006–2007
Summary
Clinicians in the UK, and elsewhere in Northern Europe and North America, noticed a rise in mortality and other complications associated with the disease [2,3,4] This rise in mortality was associated with epidemiological data showing the emergence of a previously uncommon but more virulent strain of the organism known as North American pulse field type 1 or ribotype 027 (NAP1/027) [5]. This strain caused increased numbers of cases, and greater severity of disease by virtue of increased toxin production [6], as well as enhanced resistance to commonly used classes of antibiotics [2,7].
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