LOS ANGELES — Several hospitals faced with outbreaks of a virulent strain of Clostridium difficile brought the spread of disease under control with stepped-up infection control measures and altered antibiotic prescribing practices.
Early identification of cases, isolation precautions, cleaning of rooms with a bleach solution, replacement of alcohol-based hand rubs with soap and water, and targeted antibiotic restrictions all were cited in institutional success stories described at the annual meeting of the Society for Healthcare Epidemiology of America.
Mary K. Blank described a multipronged strategy used at the University of Pittsburgh Medical Center that brought the incidence of hospital-acquired C. difficile infection down from a high of 7.2 per 1,000 discharges in 2000 to 4.6 per 1,000 in 2004.
The University of Pittsburgh was one of the first hospitals to report the emergence of a highly toxic strain of C. difficile associated with increased colectomies and patient deaths. A crackdown on C. difficile began in 2000 with active surveillance. At-risk patients were identified on the basis of prolonged length of stay, antibiotic use, high or low white blood cell count, and/or bandemia.
Patients with symptoms suggesting C. difficile infection were isolated and all charts were electronically flagged when the diagnosis was made. Clinicians and other staff members were informed of heightened infection-control requirements maintained throughout the patient's stay. Rooms were cleaned with a 1:10 bleach solution, and alcohol-based hand cleaners were replaced with soap and water.
A C. difficile management team treated each patient, prescribing oral or intravenous metronidazole for most of them, often in conjunction with oral vancomycin for 14 days.
A case-control study linked the use of levofloxacin, clindamycin, and ceftriaxone to the hospital's outbreak, so physicians were required to get prior approval for using those drugs.
At Northwestern University, similar precautions were implemented following the C. difficile-related deaths of two patients in 3 days who had been housed in adjacent rooms in an oncology unit.
An investigation identified 8 patients in the oncology and medical intensive care units colonized with the outbreak strain and 17 patients in those and other units colonized or infected with another toxigenic strain of C. difficile.
Staff alerts, enhanced case identification, intensified infection control and isolation practices, and terminal bleaching of rooms when patients were transferred or discharged brought the outbreak under control, reported Shilpa M. Patel, M.D., a fellow in the department of infectious disease.