Infection control practices related to Clostridium difficile infection in acute care hospitals in Canada

Background

We carried out a survey to identify the infection prevention and control practices in place in Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP).

Methods

An infection prevention and control practices survey was sent to CNISP hospitals at the beginning of November 2004, the same time that CNISP started a 6-month prospective surveillance for Clostridium difficile infection (CDI) to evaluate their infection prevention and control measures and laboratory methods for C difficile.

Results

A total of 33 hospitals completed and returned the survey. Infection control precautions were initiated in 18 hospitals (55%) due to the presence of a symptomatic patient before the C difficile laboratory tests were available. All of the hospitals used gloves and gowns as additional precautions. Twenty-three hospitals (70%) tested liquid stools based on a clinician's order, and 8 (24%) tested all liquid stools submitted whether of not C difficile testing was requested. The hospitals used 1 of 3 different products as a standard hospital-wide disinfectant; 24 (73%) used a quaternary ammonium compound, 8 (24%) used accelerated hydrogen peroxide, and 1 (3%) used a hypochlorite solution (1:10 bleach solution).

Conclusion

Although the hospitals used contact precautions quite uniformly, considerable variation was seen among hospitals in terms of testing strategies, cleaning and disinfection protocols and products, and isolation practices. The timing for the initiation of infection control precautions is important to prevent secondary transmission of CDI. Most of the hospitals implemented precautions while waiting for the toxin assay results.

a Centre for Communicable Diseases and Infection Control, Public Health Agency of Canada, Ottawa, Ontario, Canada

b University Health Network, Toronto, Ontario, Canada

c University of Alberta Hospital, Edmonton, Alberta, Canada

d SMBD–Jewish General Hospital, Montreal, Quebec, Canada

e Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada

f Mount Sinai Hospital, Toronto, Ontario, Canada

g Health Sciences Centre, St. John's, Newfoundland, Canada

h Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada

i National Microbiology Laboratory, Public Health Agency of Canada, Winnipeg, Manitoba, Canada

Address correspondence to Denise Gravel, BScN, MSc, Nosocomial and Occupational Infections Section, Public Health Agency of Canada, 100 Eglantine Driveway, PL 0601E2, Ottawa, Ontario, K1A OK9.

Conflicts of interest: The authors report no conflicts of interest.

PII: S0196-6553(08)00753-0

doi:10.1016/j.ajic.2008.07.012

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