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Clostridium difficile– associated disease (CDAD) is associated with increased length of stay, cost of care, and significant morbidity and mortality. The adult blood and marrow transplant population is at high risk for infection due to multiple factors. These factors include: prolonged neutropenia, antimicrobial use, conditioning regimens, immunosuppression, and the suppression of gastric acid. Starting in May 2013, our unit saw a sharp increase in our hospital acquired CDAD. Our goal was to decrease the number of hospital acquired CDAD infections on our unit by implementing new practice guidelines.
Methods, Intervention, & Analysis
In June 2013 our unit educator and CNS along with our coordinating council developed new practice guidelines to control the spread of Clostridium difficile. These guidelines were developed to be used in addition to our hospital's comprehensive infection control policy. The new guidelines included universal gloving for all patient contact, restricting our unit kitchen to staff only, double bagging isolation linens and garbage, bleaching the linen carts after use and bleach wiping high touch-point areas in isolation rooms three times a day. We also put signs outside of each C. difficile room instructing visitors and staff to wash with soap and water. We began bleach wiping high touch-point areas throughout the unit on a daily basis. These guidelines were emailed to staff and also reviewed in monthly staff meetings.
Findings & Interpretation
In the Spring/Summer of 2013, our unit had the highest rates of CDAD in the hospital. Our peak rate was 14.2 per 1000 patient days. Through our new guidelines, we were able to decrease our rate to 2.8 per 1000 patient days.
Discussion & Implications
C. difficile infection prevention is an on-going process. This summer, our unit saw a small spike in infection rates, and with re-education of last year’s guidelines via email and staff meetings, we’ve seen our rates decrease again.