Clostridium difficile: tricky and sticky but can be readily nailed!

Beth Bint 1, Joanna Harris 1

Illawarra Shoalhaven Local Health District, Wollongong, NSW, Australia


Clostridium difficile infection causes diarrhoea (CDAD) that can range between mild symptoms that can be effectively treated with oral antimicrobials, to intractable disease requiring complex medical and surgical interventions. Being a spore forming organism, environmental contamination poses a risk for healthcare endemicity. For this reason, healthcare-associated CDAD (HA-CDAD) and overall burden are carefully monitored.During the 2nd half of 2015 an unusually high number of HA-CDAD cases, representing a doubling of the previous 4 years monthly average, were reported, distributed widely across a 500 bed hospital in NSW.

An executive outbreak management team was formed to develop and prioritise improvement strategies. A review of all HA-CDAD cases from July 2015 was undertaken to identify common factors indicating possible cross-infection opportunities. Broad-spectrum antibiotic usage, and compliance with environmental and equipment cleaning procedures were audited. Enhanced environmental controls were implemented, including increased cleaning and disinfection in rooms accommodating CDAD patients and routine cleaning and disinfection of all vacated beds. Staff knowledge deficits were identified and addressed.

Improvement strategies were commenced in October 2015. By December 2015 the rate of HA-CDAD acquisitions had halved and have been sustained at pre-outbreak rates.

Although many co-morbidities and treatments can increase the risk of CDAD affecting an individual, the role of the hospital environment has a profound influence on transmission. With executive support, and engagement with the hotel services department and clinical teams, barriers were navigated to ensure timely improvements in environmental controls leading to sustained reduction in CDAD at this hospital.

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