Reduction of Clostridium difficile infection in a community-based hospital using hypochlorite solution

Abstract

BACKGROUND/OBJECTIVES: This medical center (MC) is a 400-bed community-based hospital in suburban St. Louis County. There was concern that the incidence of C. difficile was increasing. Therefore, an intervention study was initiated to improve C. difficile rates. METHODS: A case was defined as a patient with diarrhea and +C. difficile > 48 hours after admission. In January 2004, the definition was expanded to include a patient with a + C. difficile on admission and who was an MC inpatient within the past 60 days. Daily and discharge cleaning of the C. difficile patient room with a 1:10 bleach solution was initiated. Rooms were to be cleaned daily with a 1:10 solution of bleach and water, using a different wiping cloth for each room. Staff was instructed to wipe down bedside rails, which is not usually done until discharge. Education on C. difficile, transmission, and prevention was delivered. The bleach intervention was piloted in two areas from August 2003 through January 2004, and disseminated housewide in February 2004. Housekeeping was informed to implement the bleach protocol by the designation of the letter “B” on the contact isolation sign outside the patient room. An e-mail was also sent to the housekeeping supervisors notifying them of new C. difficile patients. RESULTS: From February 2002 to January 2004, the C. difficile rate was 2.2 per 1000 patient days. Post bleach and education intervention, the rates decreased to 1.5 per 1000 patient days. The rate decline was statistically significant. (p = 0.00007). CONCLUSIONS: The routine use of bleach cleaning in C. difficile rooms and education on preventing the transmission of C. difficile significantly decreased the C. difficile rate at MC.