Admission Toxigenic C. Difficile Surveillance to Reduce Hospital Onset C. Difficile Infection (CDI)

Background:

Clostridium difficile infection (CDI) remains a constant, even increasing, clinical infection threat in the United States and Europe. New preventive strategies are urgently needed. Current control measures do not target asymptomatic carriers, despite evidence that they can contaminate the hospital environment and health care workers' hands; a risk to potentially transmit C. difficile to other patients. Of special importance is that not only is disease prevalence increasing, but severity of illness and mortality also is on the rise. The investigators have implemented many interventions at our healthcare system including bleach cleaning of rooms with CDI patients, monitoring of environmental services' room cleaning, hand hygiene education and even UV light disinfection of rooms harboring CDI patients, and none have been consistently effective. The investigators believe that CDI is much like methicillin resistant Staphylococcus aureus (MRSA), in that many more patients are colonized than infected, and one (perhaps the optimal) way to curtail disease is to interrupt transmission by identifying carriers and placing them into contact (glove and gown) precautions.

The investigators propose to test this hypothesis with a quality improvement program study at NorthShore. The primary goal is to demonstrate that surveillance testing for C. difficile colonization at the time of admission and contact precaution isolation of those positive will reduce spread of the organism as well as lower clinical CDI. The investigators secondary goals are to demonstrate a reduction in C. difficile infection incidence after implementation of this program and demonstrate that such a program is cost effective.

Study Methods:

We have collected CDI disease rates for 10 years. One of our hospitals admits a high number of patients from long term care facilities (LTCFs) and currently has a rate of infection at 11 cases/10,000 patient days, and this facility served as a pilot site in the program initiative. The nosocomial CDI rate at this facility had been rising during the first quarter of 2016. The investigators plan to introduce peri-rectal (intra-anal) swab testing for C. difficile on all admissions accompanied by isolation of positive patients, which the investigators hypothesize will lower the rate to 3 cases/10,000 patient days. In absolute numbers, the goal is to reduce the rate from 4 nosocomial cases per month down to 1 nosocomial case per month. This is intended to provide a sample size that can demonstrate a level of significance at p<.05 for disease reduction with the intervention when compared to the same time frame prior to the admission testing intervention.