Do bay closures prevent the spread of C. difficile?

Abstract

A 48-hour bay closure policy designed to limit onward transmission of gastrointestinal pathogens was in place at a London NHS Trust between March 2007 and April 2010. This policy required the closure of beds to admissions and transfers for 48 hours in a bay where a patient with a potential gastrointestinal infection was identified. The aim of this study was to establish the efficacy and operational impact of this policy, and implications for infection prevention and control team resources. It involved a retrospective review of patients involved in bay closures between January and March 2010, excluding those associated with norovirus. During the three month period 252 bay closures were identified, a rate of 2.07 of per 1000 bed days. In 191 cases, data was available on affected patients and in 30 (16%) a gastrointestinal pathogen was identified in the index patient, 28 of which were C.difficile. In two (1%) of the bay closures for which data were available, a “contact” patient was identified with the same organism as the index case, but only after the 48-hour closure period. This policy was unlikely to reduce the transmission of C.difficile, and administering the policy required considerable infection and prevention and control team resources, and had a major impact on bed capacity.