Control and Prevention of C. Difficile (CD) Outbreaks with a Multidisciplainary Program in a Coummunity Hospital

      ISSUE: Three nosocomial outbreaks of C. difficile diarrhea were identified over a four-month period in a community hospital. Upon study of the four outbreaks, a common trend was noted to be a delay in recognizing and isolating symptomatic patients. This delay prevented proper cleaning and disinfection of patient rooms/equipment, as well as heightened hand hygiene efforts to prevent nosocomial transmission.
      PROJECT: The Infection Control Practitioner gained the support of nursing leadership and worked collaboratively with a multidisciplinary team including Nursing, Education, Pharmacy, Laboratory, Environmental Services and the Medical Staff to control current cases and prevent further outbreaks. Education on C. difficile was provided to Nurses on all shifts concentrating on the following key points: 1) Signs and symptoms of C. difficile, 2) Identifying patients at risk, 3) Proper hand hygiene with soap and water (not alcohol gels) while caring for C. difficile patients, and, 4) Presumptive isolation of all symptomatic patients while working with physicians to diagnose those patients. Nurses were also encouraged to attend continuing education programs on C. difficile. The hospital Pharmacist evaluated patients and provided feedback to physicians regarding appropriate antibiotic usage. In-services were held for Environmental Services staff regarding proper cleaning procedures for areas with affected patients. The Environmental Services department received notification directly from the Laboratory on all patients who tested positive for C. difficile and directly from the Infection Control Practitioner for patients who were suspect. Environmental Services personnel promptly initiated enhanced cleaning procedures which included the use of 10% bleach instead of the hospital-approved disinfectant. Physicians were informed of these process changes during regularly scheduled medical section meetings.
      RESULTS: The multidisciplinary process changes were well accepted and enforced house-wide. There have been no further outbreaks nor documented nosocomial transmission of C. difficile for a period of three months.
      LESSONS LEARNED: A multidisciplinary approach involving Infection Control, Nursing, Environmental Services, Pharmacy, the Laboratory, Education, and the Medical Staff is required to control and prevent nosocomial C. difficile transmission.