PREVENTING CLOSTRIDIUM DIFFICILE INFECTION

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
• gt300,000 cases/year
• 90 of patients with CDAD have skin contamination
  
• 60 of patients have skin contamination after
  clinical resolution

4
(No Transcript)
5
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.

6
The Clostridium difficile Cycle
7
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. 200417147-48.
8
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.

9
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.

10
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

11
(No Transcript)
12
(No Transcript)
13
Strict Glove Use
14
Hand Hygiene

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

15
Bacteria Commonly Found in the Environment
40
20
Bed Rail
Supply Cabinet
Bedside Table
Adopted from Speck SHEA Abstract 167,
Baltimore, April 2007
16
How long can a organism live if we do not clean
with a disinfectant?

• C. difficile gt 5 months 1
• Staph aureus 5 months
• VRE 4 months
• Acinetobacter 5 months
• Viruses 2-8 hours 2

17
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

18
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

19
Antibiotic Stewardship
20
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