Hospital-Acquired C. Diff Incidence Reduced by Multidisciplinary Approach

A hospital reduced the incidence of hospital-associated Clostridium difficile infections by 70% and reduced annual associated mortality in patients with hospital-associated C. difficile by 64% through successive implementation of five rigorous interventions.

To measure and reduce the incidence of hospital-acquired C. difficile, a multistep process based on a risk assessment was implemented and developed. Additional data sets were monitored including associated mortality and morbidity as measured by C. difficile-related colectomies. The sensitivity of C. difficile toxin detection in stool specimens was improved to reduce false-negative results. Environmental cleaning of patient rooms and equipment was enhanced.

Investigators at Rhode Island Hospital (Providence, RI, USA; www.rhodeislandhospital.org) monitored the number of C. difficile infections per 1,000 hospital discharges from the second quarter of 2006 to the third quarter of 2012, and found that hospital-associated C. difficile infections were reduced from a peak of 12.2 per 1,000 to 3.6 per 1,000 discharges. Additionally, the mortality in patients associated with this infection was reduced from a peak of 52 in 2006 to 19 in 2011, and by the end of the third quarter of 2012, that number was down to 13.

"This is a significant, hospital-wide effort involving the support of hospital administration, the department of epidemiology and infection control, nursing, medicine, surgery, pathology, pharmacy, environmental services, and the microbiology lab. It is truly a multidisciplinary effort to make the hospital safer for our patients, their families and our staff," said Leonard Mermel, DO, medical director of the department of epidemiology and infection control at Rhode Island Hospital.

"By working together to better monitor those patients at risk, enhance the cleaning of patient rooms and equipment, and to use contact precautions as appropriate, we were able to significantly reduce the risk of this virulent infection and ultimately to provide better, safer patient care."

According to the Centers for Disease Control and Prevention (CDC, Atlanta, GA, USA; www.cdc.gov) 94% of C. difficile infections are related to receiving medical care, and hospital stays from this infection tripled in the last decade, posing a patient safety threat especially harmful to older Americans. The infection causes diarrhea linked to 14,000 American deaths each year.

The results of the rigorous multidisciplinary approach that resulted in fewer infections as well as deaths associated with hospital-onset C. difficile were reported in the July 2013 issue of the Joint Commission Journal on Quality and Patient Safety.

Related Links:
Rhode Island Hospital
Centers for Disease Control and Prevention