Blog | Tuesday, September 3, 2013

A multidisciplinary, multifaceted approach to C. difficile prevention works


Clostridium difficile=bad.

Many good people doing a lot of good things to prevent C. difficile=priceless.

That’s the basic summary of a recent report in the Joint Commission Journal on Quality and Patient Safety by Len Mermel and colleagues at Rhode Island Hospital. Faced with a high burden of C. difficle infections, they implemented a series of six “interventions” targeting C. difficile between 2006 and 2012. These interventions were: (1) develop a C. difficile hospital infection control plan based on a risk assessment; (2) monitor hospital-wide morbidity and mortality associated with C. difficile infection; (3) improve sensitivity of C. difficile toxin detection in stool specimens using a PCR assay; (4) enhance environmental cleaning of patient rooms and equipment; (5) develop a C. difficile infection treatment plan; and (6) conduct other interventions including attempting antimicrobial stewardship.

Overall, the results were impressive with a 70% reduction in incidence. From a peak of 12.2 cases per 1,000 discharges in 2006 rates fell to 3.6/1,000 discharges in 2012 with comparable declines in CDI-related mortality. Using time-series analysis they reported a change in slope of quarterly healthcare-associated CDI cases per 1,000 discharges after each intervention, which you can see in the figure below. The slopes of each line are associated with (from left to right) the (1) pre-intervention period, (2) education, outcome reporting and room cleaning monitoring, (3) bleach product use for room cleaning, (4) PCR testing (5) additional room cleaning personal hired with defined responsibilities, (6) equipment cleaning training and monitoring.

Here is the link to the full text of the article (subscription required). Is it me or should Joint Commission’s journal be open access in 2013?

Eli N. Perencevich, MD, ACP Member, is an infectious disease physician and epidemiologist in Iowa City, Iowa, who studies methods to halt the spread of resistant bacteria in our hospitals (including novel ways to get everyone to wash their hands). This post originally appeared at the blog Controversies in Hospital Infection Prevention.