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PREVENTING CLOSTRIDIUM DIFFICILE INFECTION

PREVENTING CLOSTRIDIUM DIFFICILE INFECTION. Oklahoma Foundation for Medical Quality 14000 Quail Springs, Suite 400 Oklahoma City, OK 73134. Clostridium difficile. Anaerobic, gram-positive, spore-forming, toxin-producing bacillus

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PREVENTING CLOSTRIDIUM DIFFICILE INFECTION

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  1. PREVENTING CLOSTRIDIUM DIFFICILE INFECTION Oklahoma Foundation for Medical Quality 14000 Quail Springs, Suite 400 Oklahoma City, OK 73134

  2. Clostridium difficile • Anaerobic, gram-positive, spore-forming, toxin-producing bacillus • Spores germinate into vegetative bacteria in the small intestine • Spores survive in the environment 5-6 months • Alcohol gel does not kill spores • Spores are removed from our hands with soap and water

  3. Clostridium difficile associated Diarrhea (CDAD) • 10%-20% of cases of antibiotic-associated diarrhea • Around 85% of cases of antibiotic associated colitis • >300,000 cases/year • 90% of patients with CDAD have skin contamination • 60% of patients have skin contamination after clinical resolution

  4. Costs • CDI is associated with an increased length of stay by 2.6 to 4.5 days • $2,500 to $3,500 per episode • Cost management of this infection exceeds $3.2 billon annually • Mortality rate of 6.9% at 30 days and 16.7% at one year APIC Guide to the Elimination of Clostridium difficile in Healthcare Settings, 2008.

  5. The Clostridium difficile Cycle

  6. C. difficile Bundle Early detection Contact isolation Strict Glove Use Hand Hygiene with Soap and Water Minimize number of patients per room Intensified housekeeping measures Dedicated equipment Antibiotic Stewardship Loo VG, et al. Can Med Assoc J. 2004;171:47-48.

  7. CONTACT ISOLATION • Early Presumption Isolation • If liquid diarrhea place patient in Contact Isolation • Isolate in Private Rooms • When can I request a patient be removed from Isolation? • When diarrhea is gone for 24 hours • If patient placed in presumptive isolation, remove when 3 stool samples are negative, collected 1 day apart and WBC and temp are normal • Send Stool samples to the lab within 2 hours of collection or refrigerate.

  8. C. difficile Infection • Within hospitals and chronic-care facilities, cross-infection of C. difficile has been related to transient carriage on hands of healthcare workers and contamination of diverse environmental surfaces.

  9. FACTORS OF DISEASE ACQUISTION • Fecal-Oral Transmission - means ingestion of spores • Antibiotic/Disruption of colonic normal flora • Hospital length of stay • 13% colonization after 1 week of stay • 50% colonization after 4 weeks of stay • C. difficile can survive on environmental surfaces 5 to 6 months

  10. Strict Glove Use

  11. Hand Hygiene • Alcohol gel is ineffective against Clostridium difficile spores • Use Soap and Water with friction to remove Clostridium difficile spores from your hands

  12. Bacteria Commonly Found in the Environment 40 20 Bed Rail Supply Cabinet Bedside Table Adopted from – Speck SHEA Abstract 167, Baltimore, April 2007

  13. How long can a organism live if we do not clean with a disinfectant? • C. difficile > 5 months1 • Staph aureus 5 months • VRE 4 months • Acinetobacter 5 months • Viruses 2-8 hours 2

  14. Dedicated Equipment • Dedicated equipment if possible • B/P cuff, Stethoscope, Thermometer • Use disposable Thermometers if possible- the handles become contaminated • Disinfect all equipment between patients

  15. Outbreaks and Transmission • Hypochlorite-based disinfectants have been used with some success for environmental surface disinfection in those patient-care areas where surveillance and epidemiology indicate ongoing transmission of C. difficile • Consult Product Information and CDC Disinfection Guidelines

  16. Antibiotic Stewardship

  17. Questions This material was prepared by Oklahoma Foundation for Medical Quality, the Medicare Quality Improvement Organization for Oklahoma,under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. HAI-1110-OK-0810

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