Infection control program and active surveillance can reduce incidence of impatient C. diff infections

A comprehensive infection control program combined with an active surveillance process significantly reduced the incidence of Clostridium difficile (C. diff) infections in a long-term acute care hospital, according to a study published in the Journal for Healthcare Quality, the peer reviewed publication of the National Association for Healthcare Quality (NAHQ).

C. diff is the second most common nocosomial infection in U.S. hospitals and patient risk factors include extended hospitalization, advanced age, multiple co-morbidities, and exposure to antimicrobial products. C. diff is especially problematic in long-term acute care hospitals that treat ventilator-dependent and immune-compromised patients who have been treated with antibiotics. Patients with diarrhea are the major source of C. diff transmission via contaminated environments and from the hands of healthcare workers. It is estimated that patients with C. diff infections remain hospitalized for an additional seven days, and the estimated cost for each episode of C. diff is $5,000.

Betsy Brakavich, RN MSN, vice president and chief nursing officer, Wellstar Windy Hill Hospital in Marietta, Ga., reviewed results of a 2009 tiered infection control program in the 50-bed long-term acute care center. The program included environmental cleaning and disinfection, diagnostics and surveillance, and infection control measures, which included antibiotic stewardship. The goal was to decrease the incidence rate of C. diff by 15 percent within six months.

Prior to implementing the program, the environmental services staff received training on appropriate cleaning and disinfection of patient rooms. Microfiber mops were used instead of cotton strong mops because microfibers consistently remove a larger proportion of organisms associated with hospital-acquired infections.

A new diagnostic test for C. diff was used for testing unformed stools, and patients with negative results were considered to be free of C. diff infection. Infection control measures included contact isolation for all patients with a positive diagnosis of C. diff. New isolation signs for patient room doors informed staff and families about appropriate isolation attire. Hand washing was strongly enforced and hand sanitizers were removed from the rooms. "Strict adherence to hand hygiene is an absolute necessity to avoid transmission of C. diff between patients and the community," said Brakavich.

Antimicrobial stewardship steps included minimizing the frequency and duration of antimicrobial therapies and restriction of clindamycin and cephalosporins. Patients were assessed for signs and symptoms of C. diff before admission and were asked about antibiotics they had been taking.

Prior to starting the C. diff control program, the hospital's incidence rate was 56.52. After 12 month, the rate was 34.36 and fell to 31.51 after two years. The overall C. diff incidence at the end of 24 months had dropped by 44.25 percent.

"This study clearly shows the tiered program of environmental cleaning and disinfection, diagnostics and infection control measures helped to decrease the incidence of C. diff in long-term acute care hospitals," said Brakavich. "These are essential interventions for protecting patient safety."