Multiple Interventions Used to Lower Clostridium difficile– Associated Diarrhea Rates in a Large Urban Hospital

Abstract

BACKGROUND: Clostridium difficile–associated diarrhea (CDAD) is a common nosocomial infection. CDAD has been associated with prolonged use of antibiotics. C. difficile spores, which are present in stool, can live for up to 70 days and are often spread by the hands of healthcare professionals. METHODS: An increased rate of CDAD was noted in June and July 2002 at Barnes-Jewish Hospital, a 1442-bed tertiary care hospital in St. Louis, Missouri. The CDAD rate for the hospital in the first 5 months of 2002 was 2.8 cases/1000 patient-days. The rate in June and July was 6.2 cases/1000 patient-days (p<0.001). A computerized laboratory surveillance tool helped infection control specialists promptly identify the rise in CDAD rates. Unit-specific interventions were performed in two ICUs. The surgical ICU (SICU) (10.4 cases/1000 patient-days in July 2002) instituted enhanced environmental cleaning, including bleach, in rooms of CDAD patients. The medical ICU (MICU) (25 cases/1000 patient-days in June 2002) intensified active surveillance, including monthly reporting of CDAD rates to the ICU staff. Additionally in this unit, rooms of CDAD patients were bleached at discharge. A hospital-wide hand hygiene intervention was also implemented between January and April 2003. RESULTS: The hospital's overall CDAD rate decreased to 2.5 cases per 1000 patient-days in the last 5 months of 2002 (p<0.001). The CDAD rate in the SICU dropped to 4.8 cases/1000 patient-days (p=.20) after the start of the intervention. Since the implementation of the intervention in the MICU, the CDAD rate has decreased to 5.1 cases/1000 patient-days (p<0.001). The hospital CDAD rate dropped to 2.1 cases/1000 patient-days (p<0.001) in the months following the hand hygiene intervention. CONCLUSION: Early recognition allows prompt interventions to address infection control issues such as this increase in CDAD rates. The use of multidisciplinary interventions to reduce CDAD infection rates was a successful strategy in this case.