Effectiveness of infection control program in controlling nosocomial Clostridium difficile☆

https://doi.org/10.1053/ic.1998.v26.a84773Get rights and content

Abstract

Objective: To report the effectiveness of use of comprehensive infection control measures to reduce the incidence of Clostridium difficile (CD) in an acute-care teaching hospital. Methods: All CD infections were reviewed by the infection control coordinator from 1987 to 1996. The Centers for Disease Control and Prevention’s nosocomial infection definition was used. CD-inclusion criteria remained unchanged during the study period. Interventions were started in 1990. Interventions: The interventions used were: (1) Isolation policy-revision and enforcement, which included universal precautions policy, (2) educational program-monthly to all health care workers, (3) phenolic disinfectant for environmental cleaning, (4) triclosan (0.03%) soap for handwashing, (5) centralization of sterilization department, (6) cart-washer installation, and (7) aggressive surveillance activity. Results: From 1987 to 1989, before the interventions, a total of 466 CD infections (mean 155 per year) occurred. From 1990 to 1996, after the interventions, 475 infections (mean 67 per year) occurred. Incidence of CD decreased by 60% from 1990 to 1996. Conclusion: The sustained decrease of nosocomial CD during the 7-year period demonstrated the effectiveness of aggressive infection control measures that involve multiple disciplines. (AJIC Am J Infect Control 1998;26:588-93)

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METHODS

Columbia Arlington Hospital is a 350-bed acute-care community teaching hospital in Arlington, Va. Yearly total admissions remained almost the same during the study period (1987–1996). Total admissions per year range from 17,500 to 18,500. The average length of stay by patients decreased from 6.5 days before the intervention to 4.5 days after the intervention. Fifty percent of all hospital patients were older than age 45 years, and 40% of these patients were male. All the interventions were

RESULTS

During the 10-year period (1987–1996) studied, 941 CD infections occurred (Fig 1).Before implementation of infection control measures, a total of 466 CD infections (mean 155 per year) occurred. After the intervention in 1990, the total incidence was 475 infections (mean 65 per year); incidence was reduced by 60% (P < .05).

The clinical features of infections were moderate to severe diarrhea. No cases of severe hemorrhagic colitis or other serious symptoms were reported. Most patients were

DISCUSSION

A multidisciplinary approach was taken to prevent CD infections by controlling the reservoirs, which can be patients, environments, or patient-care equipment. The literature shows that no one method has been uniformly effective in the interruption of nosocomial spread of CD, for which we adopted several different methods.1

Infection control education was the means of our success. This intensive education on prevention of CD started in April 1990. The infection control coordinator was readily

Acknowledgements

We thank Sarah T. Wright, MLS, for her assistance in the preparation of this article.

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From Infection Control,a Administration,b Infectious Diseases,c Pharmacy,d Quality Assurance,e Columbia Arlington Hospital.

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Copyright © 1998 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Mosby, Inc. All rights reserved.