Hands Of Staff Research Articles

Investigation of a nosocomial outbreak by alginate-producing pan–antibiotic-resistant Pseudomonas aeruginosa

The nosocomial spread of pan-antibiotic-resistant nonfermentative bacteria is an increasing concern. This study investigated the microbiologic and epidemiologic characteristics of a hospital outbreak due to alginate-producing, pan-antibiotic-resistant Pseudomonas aeruginosa (PAR-Pa). All patients with infection with a P. aeruginosa strain that was resistant to all Clinic Laboratory Standards Institute-suggested antimicrobial agents between November 2004 and May 2005 were included in the study. Alginate production detection and pulsed-field gel electrophoresis (PFGE) typing were done for the patient and environmental surveillance isolates. A matched case-control study was performed to identify risk factors and evaluate outcomes. PFGE analysis of a total of 35 PAR-Pa isolates (28 patient and 7 environmental surveillance isolates) identified a single epidemic clone as responsible for the outbreak. All epidemic isolates were alginate-producing and susceptible only to colistin. The Student t-test demonstrated that a longer stay in the intensive care unit (ICU) (6.64 days vs 1.83 days; P < .05) significantly increased the risk of PAR-Pa infection. Systemic PAR-Pa infection resulted in higher mortality (85.7% vs 27.8%; P < .05). Multivariate analysis determined that therapeutic failure (odds ratio = 24.7; 95% confidence interval = 4.144 to 147.221; P < .05) was the independent risk factor related to this high mortality. Localized PAR-Pa infections were associated with longer hospital stays (46.2% vs 14.4%; P < .05) and higher rates of surgery (85.7% vs 15.4%; P < .05) and amputation (42.8% vs 0%; P < .05). The recovery of the pathogen from staff hands and frequently handled surfaces suggests possible handborne transmission. Improved hygienic standards and application of strict contact precautions, including isolation, reduced the spread of the pathogen. This study illustrates the ability of pan-antibiotic-resistant P. aeruginosa to cause an outbreak with significant mortality and stresses the need for precautions to prevent the spread of such highly resistant strains.

Procedural Sedation Safe in the Hands of ED Staff

Procedural Sedation Safe in the Hands of ED Staff

Coagulase-negative staphylococci isolated from bovine extramammary sites and intramammary infections in a single dairy herd

Isolates of various species of coagulase-negative staphylococci (CNS) from extramammary swab samples were compared with isolates of bovine mastitis CNS species. Swab samples were taken from perineum skin and udder skin, teat apices and teat canals of lactating dairy cows of the research dairy herd of the University of Helsinki in 1999 and 2002. In addition, hands of herd staff and liners of teat cups were sampled for CNS. CNS isolates from milk samples of subclinical or clinical mastitis in the same herd were collected during 1998-2002. Species identification was performed using phenotyping (API Staph ID 32 test) and by constructing a 16 and 23S rRNA RFLP library (ribotyping). Based on phenotype, 84% of mastitis isolates and 57% of extramammary isolates were identified at species level with >90% probability. Ribotype patterns formed 24 clusters, and 15 of them included a CNS type strain. If the ribotype clusters contained isolates of both extramammary and mastitis origin, they were further typed using pulsed-field gel electrophoresis (PFGE). The predominant CNS species in mastitis, based both on phenotyping and genotyping, were Staph. chromogenes and Staph. simulans. Phenotyping failed to identify half of the extramammary isolates. Based on phenotyping, Staph. equorum and Staph. sciuri, and based on ribotyping, Staph. succinus and Staph. xylosus, were the predominant CNS species in extramammary samples. The most common species in milk samples, Staph. chromogenes, was also isolated from several extramammary samples, and five out of ten pulsotypes were shared between mastitis and extramammary isolates, indicating that strains from udder skin are highly similar. The second commonest mastitis species, Staph. simulans, was isolated only from three extramammary samples, indicating that Staph. simulans may be more specifically associated with mastitis. Consequently, the origin of CNS mastitis may vary depending on the causing CNS species.

Procedural Sedation Safe in the Hands of ED Staff

Procedural Sedation Safe in the Hands of ED Staff

Molecular epidemiology of Acinetobacter baumannii spread in an adult intensive care unit under an endemic setting

Acinetobacter baumannii (Ab) clones I, III, and IV were recovered in several Buenos Aires City hospitals. We investigated the prevalence of these clones with epidemic behavior (EB) in our intensive care unit (ICU) under an endemic setting and its spread. A 10-week prospective cohort study including surveillance cultures of newly admitted patients was conducted. Air, environment, and staff hands were weekly screened. In the seventh week, a new environmental cleaning protocol and a staff hand hygiene reeducation program were implemented. Almost 15% of all screening samples (159/1042) were Ab positive. Up to the seventh week, carbapenem-resistant clone If was the main one recovered from patients, environmental frequently touched surfaces (EFTS), and staff hands screening samples. Few air samples were Ab positive. Clone I was also isolated from patients at admission. After the seventh week, a significant reduction of EFTS contamination and of clone If isolation was observed. During the last 3 weeks, clone I was no longer isolated from patients. Instead, the newly identified clone IVb was mainly cross transmitted. It was also recovered from staff hands and from EFTS. In the last week, clone If was again isolated from 1 bed rail. Patients with EB clones-positive culture at admission provide verification that interhospital patient transfers play a role in these clones spread. However, subtypes such as clone If seem to be endemic in our ICU. EFTS showed to have potential for EB clones transmission via transient staff hand carriage. Transmission did not involve airborne route.

A Program for Monitoring Staff Hand Hygiene Activity at a Small Orthopaedic Pediatric Hospital

A Program for Monitoring Staff Hand Hygiene Activity at a Small Orthopaedic Pediatric Hospital

Use of multilocus sequence typing for the investigation of colonisation by Candida albicans in intensive care unit patients

A prospective study was performed to determine the prevalence of candidal colonisation on the general intensive care unit at a large teaching hospital. Colonisation with Candida spp. was found to be common, occurring in 79% of patients on the unit. C. albicans was the commonest species, colonising 64% of patients, followed by C. glabrata (18%) and C. parapsilosis (14%). Most of the members of staff tested carried Candida spp. at some point, although carriage appeared to be transient. C. parapsilosis was the most commonly isolated species from staff hands, whereas C. albicans was the most commonly isolated species from the mouth. The molecular epidemiology of C. albicans was investigated using Ca3 typing and multilocus sequence typing (MLST). MLST proved to be a reproducible typing method and a useful tool for the investigation of the molecular epidemiology of C. albicans. The results of the molecular typing provided evidence for the presence of an endemic strain on the unit, which was isolated repeatedly from patients and staff. This finding suggests horizontal transmission of C. albicans on the unit though it may also reflect the relative frequency of C. albicans strain types colonising patients on admission. This study has important implications for the epidemiology of systemic candidal infections.

Comparação da eficácia da lavagem das mãos versus fricção alcoólica em protocolos atuais e os hábitos de consumo entre os profissionais de saúde

A higiene das mãos é um exercício primário para reduzir a transmissão por contato de agentes infecciosos. Nós avaliamos a eficácia dos utensílios usualmente utilizados pelos profissionais de saúde para a higiene das mãos. Um total de quarenta profissionais de saúde (HCWs) e de trabalhadores da administração de um hospital de ensino lavavam as mãos com água e sabão, utilizando procedimentos- padrões, mas utilizavam o álcool em gel, com e sem protocolos padronizados. Um número total de unidades formadoras de colônia nas mãos foram de 3,52 e 4,48 para os HCWs e o pessoal da administração, respectivamente (p &lt; 0,05). A média de redução do número de organismos antes e depois de quaisquer procedimentos sempre mostrou diferenças estatisticamente significativas tanto para os procedimentos padronizados quanto para os não-padronizados, e todos eles demonstraram resultados semelhantes quando comparados uns aos outros, com apenas duas exceções. Não houve nenhuma diferença na proporção de Staphylococcus aureus e bactérias Gram-negativas entre os HCWs e o pessoal da administração quando colhido o material das mãos de ambos os grupos. Este estudo demonstrou que o uso regular de álcool em gel é tão bom como lavar as mãos com água e sabão, o que poderá aumentar o hábito da higiene das mãos, especialmente em situações em que existe uma falta de pias ou quando os HCWs estiverem sobrecarregados.

D&amp;T Report

D&amp;T Report

Less is more: where do the abstracts in the EBM journal come from?

Every 2 months, a brand new issue of Evidence-Based Medicine containing 20 abstracts is published. The compact appearance belies the mounds of sifting required to arrive at the finished journal....

Validation d’un questionnaire de locus de contrôle spécifique à la blessure sportive

In the area of health psychology, locus of control (LOC) [Psychol Monogr 80 (1966) 1-28] has consistently been considered as a dimension of personality which may entail many potential benefits for the individual.Originally, the LOC by Rotter [Psychol Monogr 80 (1966) 1-28] is a unidimensional concept. He defines: on one hand individuals with an internal LOC who establish a link between their behavior and the reinforcement obtained, and on the other hand, individuals with an external LOC who do not establish any link between their behavior and the reinforcement obtained. However, since Rotter, other authors like Levenson [Distinctions within the concept of internal-external control: development of a new scale. In: Proceedings of the 80th annual convention of the American psychological association. 1972. p. 261-2] have claimed a multidimensional concept with three factors: the internal (I), powerful other (P), and chance (C). The MHLCS was constructed with three factors, according to Levenson's model. Numerous scales have been designed in order to assess health-related LOC. The most widely used is the MHLCS [Health Educ Monogr 6 (1978) 160-170]. According to Lecocq [La réhabilitation après la blessure. In: Manuel de psychologie du sport : l'intervention auprès du sportif. Paris: Revue EPS; 2003. p. 377-402], such a multidimensional view would allow in-depth examinations of sport injuries. Indeed, from a theoretical perspective, sport participants with high LOC ratings are assumed to suffer less frequent injuries than those scoring low on this dimension.The purpose of the present paper is to present an adapted version of the MHLCS in French language. For Bruchon-Schweitzer [Bruchon-Schweitzer M, Dantzer R. Introduction à la psychologie de la santé. Paris: Presses universitaires de France; 1994], the three factors (I, P, and C) are independent or a little intercorrelated. Therefore, two models of sport injury LOC scale have been studied: the first with three independent factors and the second with three dependent factors.Two hundred and sixty sports science students (170 boys and 90 girls) aged 20-26 years (S.D.=1.25 years) filled in the scale on site. We then ran a confirmatory factorial analysis (CFA) using the LISREL 8.30 software.The CFA results on both models are satisfying. However, the Chi square difference observed between the two models (chi(2)=32, ddl=3) clearly shows that the second model is more satisfying. Indeed, there seems to be a positive correlation between I and P, and a negative correlation between I and C. The second correlation result confirms Rotter's theory. A possible explanation of the first correlation would be that putting your health in the hands of medical staff is like having an indirect control over it. However, the variance percentage analysis on each item shows acceptable results for all items but four. This could be explained by the fact that Items 1 and 9 refer to healing after injury whereas the other items refer to the start of the injury. To conclude, it appears that this scale is generally satisfying, and can be a useful tool for research on the LOC and its influence on sports injuries.

Value considerations in an information ecology: Printed materials, service providers and homeless young people

We demonstrate how value considerations can be used to analyze an information ecology that has emerged to help homeless young people. We studied the information ecology of service agencies that assist homeless young people, age 13 to 25. We focused on printed materials used at the agencies and employed surveys and semi-structured interviews to gather data. Of the printed materials considered, a flier with a map of all programs was reported to be most important and distributed most frequently. Future work would further investigate distribution and usability of these portable information sources and the values they embody.

CHILD CARE-ASSOCIATED OUTBREAK OF ESCHERICHIA COLI O157:H7 AND HEMOLYTIC UREMIC SYNDROME

We present an outbreak of E. coli O157:H7 diarrhea in an urban child care center. Eleven of 45 attendees with diarrhea had positive tests (stool culture or shiga-like toxin assay) for E. coli O157:H7. Two of these 11 (18%) progressed to hemolytic uremic syndrome. Diarrheal illness in child care centers should be considered a public health risk. Staff education, hand washing, and cohorting or exclusion of attendees with diarrhea must be performed to help control infectious outbreaks.

Bacteriological Evaluation of Kwale General Hospital Environment

Bacteriological investigations were carried out on staff hands, used beddings, floors, wash basins and air in the wards of Kwale General Hospital environment, in Ndokwa West Local Government Area of Delta State. Surface swabbing and settle plate methods were employed for sampling surfaces and air respectively. Of the isolates obtained from sample sources in the hospital, beddings of patients yielded the highest proportion of bacterial load (79.2%) followed by dry floors (75.0%), air (65.9%), sinks (47.2%), staff hands (46.5%) and basins (45.2%). Female ward yielded the highest proportion of bacterial isolates of 89.3%, followed by Maternity (82.1%), male (71.4%) and children (70.4%). The least proportion of bacterial contamination occurred in Pharmacy (40.7%) and Theatre (18.5%). This study showed that Kwale General Hospital environment is heavily contaminated and therefore underlies the necessity for regular evaluation of the hospital environment. Keywords: Bacteriological evaluation, hospital, environment. Journal of Medical Laboratory Sciences Vol. 14 (2) 2005: pp. 73-78

The Disciplinary Monopoly in Development Research at the World Bank

The World Bank's internal think tank, the Development Economics Research Group (DECRG), (1) is virtually unmatched in terms of the volume, quality, and impact of its work on development issues. Among other things, its staff publish in the most prestigious scholarly and applied journals; they help produce, analyze, and disseminate the household surveys used to determine whether global poverty is rising or falling; they work closely with client counterparts around the world to help establish datasets enabling policies to be designed and programs to be placed on the basis of a comprehensive evidence base; and they design rigorous assessments to discern the impacts of development policies and projects. For all these important accomplishments and contributions, however, DECRG falls short of its potential. By promoting economics as the sole lens through which to understand and respond to the development process, it restricts what is studied, delimits how those issues are analyzed, and thereby offers clients an unnecessarily narrow menu of policy options and strategies. In short, it has established a monopoly on development research, with most of the attendant distortions that economists, ironically enough, associate with monopolies. Let us begin by stating the obvious: development is a diverse field speaking to virtually every aspect of human endeavor. As such, one might expect the core elements of this diversity to be reflected in the training of the Bank's research staff and the content of its research agenda. No single discipline can or should expect (or be expected) to be able to speak in an informed way to this diversity, yet at present all but a handful of the Bank's 100-plus research staff are economists. (2) Like any other discipline, economics is limited in its ability to pose and understand questions. This applies, we would argue, to issues within its domain, but it is more especially true of issues outside its domain. While economists have made a lot of progress in recent years in understanding key issues like institutions, collective action, and politics, the vast majority of noneconomist social scientists (and indeed many economists) would argue that areas of social, cultural, and political action are best studied by the social sciences that specialize (and thus have a comparative advantage) in these topics--namely, anthropology, sociology, political science, and psychology. Development studies, for example, is an important area of research in the noneconomic social sciences that has, over the years, provided key insights into areas that are of fundamental importance to the Bank, such as governance, participatory development, the understanding of well-being, and culture. As several influential scholars have shown, (3) development policy ignores these ideas at its peril. This oversight is especially unfortunate as the Bank finds itself becoming increasingly concerned with issues of governance, local development, and institution building. This state of affairs in DECRG both reflects and perpetuates a disciplinary monopoly that manifests itself in the fact that development policy at the Bank tends to reflect the fads, fashions, controversies, and debates of one discipline. (This is deeply ironic, since a core tenet of economic policy is to point out the collective benefits that accrue from the absence of monopolies and barriers to trade.) The strengths and limitations of economics are mirrored in its policy prescriptions: on some issues (e.g., fiscal crises, assessment of broad project impacts), it is clearly best placed to provide key policy advice; but on others (e.g., culture, process evaluations, group dynamics, conflict), it has little comparative advantage. Competing perspectives from other disciplines are simply not available to refute (or, for that matter, endorse) the economists' viewpoint or to provide other key insights that are simply absent from the toolkit of economists (or are precluded--by the prevailing assumptions, priority setting procedures, and resource allocation mechanisms--from even being considered). …

The angel in the garden suburb: Arcadian allegory in the (‘Girls’ Grounds' at the Cadbury factory, Bournville, England, 1880–1930

To the south and west of the Cadbury Chocolate factory in Bournville, a suburb of Binningham, lie 26 acres of gardens and recreation grounds. In the spring, when the daffodils along Bounville Lane are in bloom, or in the summer when a works cricket game is in progress, the factory looks almost Arcadian. The men's recreation ground and picturesque pavilion, a half-timbered turreted folly,' are still in regular use, but the garden across the road, once the ‘Girls’ Grounds’ for the female employees, is visited by only a handful of staff during their lunch hour, or by locals who wander in from Bounville Lane on a wam1 day. The garden belonged in the eighteenth and nineteenth centuries to Boumbrook Hall, a Palladian villa, demolished by the Cadburys in 1907 when they redesigned the gardens. The eighteenth-century landscaping with Edwardian additions is still clearly visible, but the lawns, shrubberies and garden buildings, although tidy, have seen better days (figure I). The pergola and pond are neglected, the summerhouse removed, the garden pavilion boarded up and the glasshouses in the kitchen garden have just been pulled down. In the 19 50S, the Cadburys employed 59 gardeners and groundsmen to maintain the grounds, provide fresh produce for the works dining rooms and copious flowers for the factory and offices, practices which continued until the 1980s.2 Today, the remaining groundsman, Calvin Green, does his best but, as with many neglected parks, dystopia threatens. The waming signs that punctuate the grounds, superficially reassuring in their purple livery, produce asense of unease - ‘Alcohol or Illegal Substances are Not Pennitted in these Grounds’ (figure 2). So why does the firm, now Cadbury Trebor Bassett, still maintain the gardens when they appear to be something of a liability and why has the land not been consumed by development like most factory landscapes? The answer lies in the patemalism of Richard and George Cadbury and their vision of a ‘Factory in a Garden’. The brothers gave the garden to their employees in 1897 and tied it up in a trust for the use of Cadbury employees only.3 The firm's plans for the future of the gardens are unclear, but they take their history seriously (£1.7 million has just been spent reroofing the I905 Girls' Baths, an English Heritage Grade 2 listed building). This paper, in drawing out the his tory of the garden and its significance in the context of industrial history and the architectural and landscape history of factories, proposes a restoration of the gardens and a programme of activities to reinstate its potential as a public park.

Implementing Alcohol-Based Hand Rub on an Ambulatory Dementia Unit

ISSUE: The use of alcohol-based hand rubs (AHR) are a popular and scientifically-accepted method of hand hygiene for many health care settings. Their use can improve compliance with optimal staff hand hygiene practice, and improve infection prevention efforts for both resident and employee safety. These products however, contain ingredients which are potentially harmful if ingested or placed into eyes. For this reason, the use of AHR in environments of clients with impaired judgement is controversial, and may be limited due to perceived risk by the staff in such a setting. This situation provides a challenge to Infection Control professionals: to provide caregivers with convenient AHR in a manner that does not compromise resident safety.

Relationship of Antimicrobial Control Policies and Hospital and Infection Control Characteristics to Antimicrobial Resistance Rates

Antibiotic misuse and noncompliance with infection control precautions have contributed to increasing levels of antimicrobial resistance in hospitals. To assess the extent to which resistance is monitored in infection control programs and to correlate resistance rates with characteristics of antimicrobial control policies, provider attitudes and practices, and systems-level indicators of implementation of the hand hygiene guideline of the Centers for Disease Control and Prevention. An on-site survey of intensive care unit staff and infection control directors of 33 hospitals in the United States was conducted. The following data were collected: antimicrobial control policies; rates during the previous 12 months of methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and ceftazidime-resistant Klebsiella pneumoniae; an implementation score of systems-level efforts to implement the guideline; staff attitudes toward practice guidelines; and observations of staff hand hygiene. Variables associated with resistance rates were examined for independent effects by using logistic regression. Resistance rates for S aureus, enterococci, and K pneumoniae were 52.5%, 18.2%, and 16.0%, respectively. Ten (30.3%) hospitals had an antibiotic control policy. No statistically significant correlation was observed between staff attitudes toward practice guidelines, observed hand hygiene behavior, or having an antibiotic use policy and resistance rates. In logistic regression analysis, higher scores on measures of systems-level efforts to implement the guideline were associated with lower rates of resistant S aureus and enterococci (P=.046). Organizational-level factors independent of the practices of individual clinicians may be associated with rates of antimicrobial resistance.

Essay: Evidence-based health-care architecture

This is a time of enormous investment in new healthcare buildings. The UK plans to create upwards of a hundred hospitals and thousands of primary-care clinics and surgery centres. In the USA, more than $200 billion will be spent on new hospitals over the next decade. This wave of construction provides an opportunity to create better buildings by use of the emerging science of evidence-based design, in which the design process is guided by an empirical understanding of the eff ects of health-care physical environments on safety, effi ciency, and clinical outcomes. The scientifi c foundation for evidence-based healthcare design is already large and surprisingly strong. A joint project at Texas AM infection rates are lower when patients are in single rather than multi-bed rooms and air quality is very good. Single rooms have advantages over multi-bed rooms in reducing airborne transmission through ventilation and the possibility of such air quality measures as fi ltration, air changes, creation of positive air pressure to protect an immunocompromised patient from airborne pathogens in adjacent spaces, or creation of negative room pressure to prevent a patient with an aerially spread infection from infecting others. Other evidence suggests that single rooms also help to decrease risk of infections spread by contact. Single rooms are easier than multi-bed rooms to clean thoroughly after a patient leaves, lessening the problem of contaminated environmental surfaces remaining as pathogen reservoirs that can spread infection through hand contact. Single rooms also enable separation or isolation of patients on admission, so that those with unrecognised infections can be identifi ed and assignment to multi-bed rooms with uninfected patients avoided. A major source of contact transmission of infection is unwashed staff hands, and low hand-washing rates among staff are well documented. Evidence suggests that hand-cleaning compliance is worse when sinks and dispensers of alcohol hand gel are positioned several paces away from staff work or movement paths, or behind doors or in other locations outside the visual fi elds of busy nurses and physicians. There are encouraging indications that installation of wash basins and gel dispensers close to staff work paths in visually prominent locations near the point of care leads to sustained increases in hand washing. Floor layouts can be designed to reduce staff fatigue and increase time for care. Conventional fl oor layouts for patient-care units generally provide corridors organised around a central nursing station, where medications and charts are located, and a central location for supplies. Nurses therefore spend much of their time walking up and down halls engaged in wasteful activity, such as fetching supplies, thereby increasing fatigue and shrinking the time available for observing patients and delivering direct care. By contrast, fl oor layouts with decentralised nurse charting or observation stations and supplies dispersed to be close to patients’ rooms cut staff time spent walking and fetching and greatly increase time for observation and care of patients. Properly designed Roger Ulrich is Professor of Architecture at Texas A&M University and a faculty fellow of the Center for Health Systems and Design, housed jointly in the colleges of architecture and medicine at Texas A&M University. He is currently Visiting Professor to the Bartlett School of Architecture, University College London. He has previously served as Senior Adviser on the Environment for Patient Care to the UK National Health Service.

Management of Increased Incidence of Clostridium Difficile Associated Diarrhea in a 90 Bed VA Nursing Home

BACKGROUND/OBJECTIVES: Incidence of Clostridium difficile associated diarrhea (CDAD) increased in a 90 bed nursing home from 1 per 100 patients(3/277) in the first quarter to 2.4 per 100 patients(6/222) in the second quarter FY04. Immediate actions included (1) Reinforcing staff hand washing with soap and water rather than waterless 62.5% ethyl alcohol hand rub for patients with undiagnosed diarrhea, (2) Changing hospital disinfectant to sodium hypochlorite solution, (3) Placing patients with undiagnosed diarrhea empirically in Contact Precautions, and (4) Increasing frequency of laboratory performance of C. difficile toxins from 3 to 7 times weekly. Rates continued to increase in the 3 rd QTR FY04 to 3.4 per 100 cases (7/233). In response, leadership appointed a Root Cause Analysis (RCA) team to analyze the problem with the objective to reduce and control the incidence of CDAD. METHODS: The RCA composed of infection control, housekeeping, nursing, medicine, pharmacy, and supply evaluated the outbreak. Recommendations included: (1) Development of CDAD medical treatment algorithm, (2) Simplification of Contact Precaution signs highlighting importance of hand washing. (3) Extensive C. difficile education for all healthcare professionals, (5) Replacement of isolation carts with Personal Protective Equipment (PPE) cabinets to improve PPE availability, and (6) Improved tracking of CDAD patients transferred in the facility to ensure continuation of precautions. Cost analysis was conducted for CDAD cases vs. non CDAD cases. Fisher's exact was applied to determine association of incidence before and after actions. RESULTS: Recommendations were implemented in the 4 th QTR FY04. Cases peaked at 4.4 per 100 patients (10/226). (p CONCLUSIONS: Management and education significantly impacted CDAD occurrence as evidenced by the decrease and control of incidence. Significant cost savings at an estimated $1,395,000 were realized with CDAD prevention activities.