scholarly journals Enhanced Cleaning and Education to Prevent Transmission of Clostridium difficile in Pediatrics

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S406-S406
Author(s):  
Anoshé Aslam ◽  
Giselle Melendez ◽  
Min Wang ◽  
Frederic Stell ◽  
Paulette Kelly ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Educational Interventions ◽  
Cancer Center ◽  
Phase 2 ◽  
Communication Plan ◽  
Effective Strategies ◽  
Key Stakeholders ◽  
Patient Representatives ◽  
Healthcare Associated

Abstract Background Transmission of healthcare-associated Clostridium difficile infection (HA-CDI) has been shown to occur directly or indirectly through a contaminated environment. At a tertiary-care cancer center, HA-CDI rates were higher for pediatric units than for other general oncology units. To address the problem, a multidisciplinary team, including Infection Control, Nursing, and Environmental Services (EVS), was convened and identified refusals and room clutter as barriers to proper cleaning of rooms on the unit. Aim: The aim of this study seeks to reduce HA-CDI in the inpatient pediatrics setting through environmental and educational interventions. Methods In the first phase of the study from February to April 2016, a baseline assessment of prevalent environmental disinfection practices was made among Nursing, EVS, Physicians, and Patient Representatives. Based on this feedback, the following were implemented during Phase 2, from June through October 2016: 1) Unit-wide disinfection with bleach twice a day including common and high traffic areas; 2) Initiation of a “preferred time for cleaning” program to engage families; 3) Enhanced visitor and family education on PPE use; 4) Creation of a communication plan in case of refusal to clean rooms; and 5) Dedicated use of diaper scales. Results During the first phase of the study, the following barriers to cleaning were identified: 1) High refusal rate as cleaning was perceived as inconvenient by families due to timing; 2) Common perception among EVS staff that multiple requests for cleaning the room may appear intrusive to the families; 3) Excessive clutter in the room; 4) Lack of education regarding PPE use; and 5) Shared equipment for diapers. To overcome these barriers, several interventions as outlined in methods were implemented. In Phase 2, there were 0 cases of HA-CDI identified in pediatric patients starting in July through October, 2016. Conclusion Control of CDI on pediatric units poses unique challenges. Engagement of key stakeholders is essential to identify and meet these challenges and to devise effective strategies that will ultimately lead to reduced hospital-based transmission of CDI. Disclosures All authors: No reported disclosures.

scholarly journals Know When to Test: Optimizing Diagnostic Practices for Clostridium difficile Infection (CDI) Among Patients at a Tertiary-Care Cancer Center

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S397-S398
Author(s):  
Anoshé Aslam ◽  
Janet Eagan ◽  
Janice Kaplan ◽  
Elizabeth Robilotti ◽  
Tracy McMillen ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Tertiary Care ◽  
Diagnostic Testing ◽  
Antibiotic Use ◽  
Cancer Center ◽  
Intervention Period ◽  
Post Intervention ◽  
Testing Algorithm ◽  
Unnecessary Testing

Abstract Background Polymerase chain reaction (PCR) based diagnostic testing for the detection of toxigenic Clostridium difficile infection (CDI) does not distinguish between carriers and patients with true CDI. As a result, CDI is over-diagnosed in hospitalized patients with diarrhea. Unnecessary testing generates false positives and several downstream sequelae. Aim: The aim of this study was to reduce unnecessary testing for CDI through an electronic alert, targeted education, and implementation of evidence-based laboratory testing policy. Methods In order to quickly identify laxative induced diarrhea and avoid CDI testing, an electronic alert was created in the electronic medical record (EMR) system. The alert was built on a logic that identified patients who had received laxatives within 48 hours of a CDI PCR test order. The alert additionally provided the rationale for avoiding testing in patients on laxatives and guidance on appropriate testing for CDI. The following steps were taken simultaneously to complement these efforts: 1) Infection Control conducted hospital-wide education for licensed independent practitioners on a CDI testing algorithm 2) Laboratory based policy was instated to reject all formed stools (Bristol Stool Chart types 1 through 4) for CDI testing. Results In the 6 month pre-intervention period, there were 29 CDI tests per 1000 patient-days. In the post-intervention period, CDI tests decreased to 19 per 1000 patient-days, a 35% decrease (P < 0.0001). The decline in testing has been sustained for 7 months. The following observations were also made: 1) HAI rate reduction of 28%; 2) decrease in oral vancomycin use. Conclusion Decreasing inappropriate testing has several distinct advantages, including reducing excessive and unnecessary antibiotic use, avoiding misclassification of carriers as CDI cases, normalizing healthcare-associated CDI rates, and diminishing healthcare costs associated with preventable tests. Laboratories that use PCR only testing for CDI diagnosis should follow stringent policies to ensure that only patients with high pretest probability are tested. EMR systems are a useful and effective resource to achieve this for patients with laxative induced diarrhea. Disclosures All authors: No reported disclosures.

scholarly journals A Nurse-Driven Protocol to Reduce Hospital-Acquired Clostridium difficile Infections

2017 ◽  
Vol 4 (suppl_1) ◽  
pp. S405-S405
Author(s):  
Deepa Nanayakkara ◽  
Eveline Mejia ◽  
Neha Nanda
Keyword(s):  
Clostridium Difficile ◽  
Early Identification ◽  
Screening Tool ◽  
Baseline Period ◽  
Misclassification Rate ◽  
Comprehensive Cancer Center ◽  
Cancer Center ◽  
Case Mix Index ◽  
Screening Protocol ◽  
Healthcare Associated

Abstract Background Clostridium difficile infection (CDI) is one of the most common healthcare-associated infections. Timely diagnosis is key to reducing associated morbidity and costs. Healthcare-onset (HO) CDI is defined as infection diagnosed 72 hours after hospitalization. Centers for Medicare and Medicaid Services has established benchmarks for HO-CDI for hospitals, which are based on several factors including type of hospital and case mix index. There is a financial penalty if we are above the benchmark. In 2016, 20% of our community-onset C. difficile (CO-CDI) cases were misclassified as HO-CDI. In order to reduce this misclassification, we established a process to assist in early diagnosis. Methods We designed and implemented a nurse-driven C. difficile screening protocol to assist in early identification of CO-CDI. Every patient admitted to Keck Hospital (KH) (401 beds) and Norris Comprehensive Cancer Center (35 beds) was screened for diarrhea within the past 24 hours. If diarrhea was present, additional questions were used to capture CO-CDI cases. A nursing order for C. difficile testing was activated for patients who met any of these criteria. Additionally, we used Bristol stool scale (BSS) to standardize stool collection. Only Bristol stool type 7 was accepted by laboratory for processing. Our study period was January 1st through April 30th, 2017 and our baseline period was January 1st through April 30th, 2016. Results Screening protocol and BSS were introduced on January 1st, 2017. During the baseline period, a total of 351 orders were placed with 31% within first 3 days of admission. During the study period, a total of 200 orders were placed with 43% within 3 days of admission. Compliance with using the screening tool was nearly 100%. Inter-rater reliability between nurses and lab for identifying the correct BSS was 100%. Baseline misclassification rate was 16%. With the introduction of this screening tool, misclassification decreased to 9%. The HO-CDI rate for the baseline period was 11.5 per 10,000 patient-days and it decreased to 6.27 per 10,000 patient-days in the study period. Conclusion We have demonstrated a reduction in HO-CDI rates by establishing a process to assist in early identification of CO-CDI. Disclosures All authors: No reported disclosures.

scholarly journals Use of culture- and ELISA-based toxin assay for detecting Clostridium difficile, a neglected pathogen: A single-center study from a tertiary care setting

2017 ◽  
Vol 9 (04) ◽  
pp. 254-259 ◽  
Author(s):  
Sujata Lall ◽  
Gita Nataraj ◽  
Preeti Mehta
Keyword(s):  
Clostridium Difficile ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Diagnostic Methods ◽  
Control Group ◽  
Toxin Assay ◽  
Stool Specimens ◽  
Diagnostic Modalities ◽  
Anaerobic Infections ◽  
Healthcare Associated

Abstract INTRODUCTION: Clostridium difficile is a Gram-positive spore-bearing anaerobic bacillus increasingly associated with both community- and hospital-acquired colitis and diarrhea. It is the most common identifiable bacterial cause of healthcare-associated diarrhea associated with antibiotic use and one of the most common anaerobic infections. The diagnosis of C. difficile infection includes detection of toxin A/B in stool specimens by direct enzyme immunoassay, culture of pathogen from the stool specimens using a selective agar Cycloserine-Cefoxitin fructose agar (CCFA), tissue culture assay, and detection of glutamate dehydrogenase an enzyme produced by C. difficile. With few reports from India on this disease, the present study was planned to throw more light on the prevalence and utility of laboratory diagnostic methods for C. difficile-associated diarrhea (CDAD). MATERIAL AND METHODS: After taking approval from the Ethics Committee, 150 patients with antibiotic-associated diarrhea were taken as a study group and fifty patients with exposure to antibiotics but who did not develop diarrhea were taken as controls. Stool specimen was processed for both culture on CCFA and toxin detection by IVD Tox A + B ELISA. RESULTS: Only four specimens were culture positive, whereas 13 were ELISA positive. All culturepositive isolates were toxigenic. C. difficile was neither isolated nor its toxin detected in the control group. Culture- and toxin-based assays may not detect all cases of CDAD. CONCLUSION: Based on the results of the present study, culture does not provide any additional yield over toxin assay. Better diagnostic modalities would be required to prove CDAD.

scholarly journals Transmission of Clostridium difficile During Hospitalization for Allogeneic Stem Cell Transplant

2015 ◽  
Vol 37 (1) ◽  
pp. 8-15 ◽  
Author(s):  
Mini Kamboj ◽  
Anna Sheahan ◽  
Janet Sun ◽  
Ying Taur ◽  
Elizabeth Robilotti ◽  
...  
Keyword(s):  
Stem Cell ◽  
Clostridium Difficile ◽  
Stem Cell Transplant ◽  
Tertiary Care ◽  
Cancer Center ◽  
Cell Transplant ◽  
Allogeneic Stem Cell Transplant ◽  
Time Space ◽  
Donor Source

OBJECTIVETo determine the role of unit-based transmission that accounts for cases of early Clostridium difficile infection (CDI) during hospitalization for allogeneic stem cell transplant.SETTINGStem cell transplant unit at a tertiary care cancer center.METHODSSerially collected stool from patients admitted for transplant was screened for toxigenic C. difficile through the hospital stay and genotyping was performed by multilocus sequence typing. In addition, isolates retrieved from cases of CDI that occurred in other patients hospitalized on the same unit were similarly characterized. Transmission links were established by time-space clustering of cases and carriers of shared toxigenic C. difficile strains.RESULTSDuring the 27-month period, 1,099 samples from 264 patients were screened, 69 of which had evidence of toxigenic C. difficile; 52 patients developed CDI and 17 were nonsymptomatic carriers. For the 52 cases, 41 had evidence of toxigenic C. difficile on the first study sample obtained within a week of admission, among which 22 were positive within the first 48 hours. A total of 24 sequence types were isolated from this group; 1 patient had infection with the NAP1 strain. A total of 11 patients had microbiologic evidence of acquisition; donor source could be established in half of these cases.CONCLUSIONSMost cases of CDI after stem cell transplant represent delayed onset disease in nonsymptomatic carriers. Transmission on stem cell transplant unit was confirmed in 19% of early CDI cases in our cohort with a probable donor source established in half of the cases.Infect. Control Hosp. Epidemiol. 2015;37(1):8–15

scholarly journals Varying Rates of Clostridium Difficile-Associated Diarrhea at Prevention Epicenter Hospitals

2005 ◽  
Vol 26 (8) ◽  
pp. 676-679 ◽  
Author(s):  
SeJean Sohn ◽  
Michael Climo ◽  
Daniel Diekema ◽  
Victoria Fraser ◽  
Loreen Herwaldt ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Hospital Admissions ◽  
Tertiary Care ◽  
The United States ◽  
Case Definition ◽  
Specific Information ◽  
Case Definitions ◽  
Data Set ◽  
Tertiary Care Centers ◽  
Healthcare Associated

AbstractBackground:Clostridium difficile-associated diarrhea (CDAD) causes substantial healthcare-associated morbidity. Unlike other common healthcare-associated pathogens, little comparative information is available about CDAD rates in hospitalized patients.Objectives:To determine CDAD rates per 10,000 patient-days and per 1,000 hospital admissions at 7 geographically diverse tertiary-care centers from 2000 to 2003, and to survey participating centers on methods of CDAD surveillance and case definition.Methods:Each center provided specific information for the study period, including case numbers, patient-days, and hospital characteristics. Case definitions and laboratory diagnoses of healthcare-associated CDAD were determined by each institution. Within institutions, case definitions remained consistent during the study period.Results:Overall, mean annual case rates of CDAD were 12.1 per 10,000 patient-days (range, 3.1 to 25.1) and 7.4 per 1,000 hospital admissions (range, 3.1 to 13.1). No significant increases were observed in CDAD case rates during the 4-year interval, either at individual centers or in the Prevention Epicenter hospitals as a whole. Prevention Epicenter hospitals differed in their CDAD case definitions. Different case definitions used by the hospitals applied to a fixed data set resulted in a 30% difference in rates. No associations were identified between diagnostic test or case definition used and the relative rate of CDAD at a specific medical center.Conclusions:Rates of CDAD vary widely at tertiary-care centers across the United States. No significant increases in case rates were identified. The varying clinical and laboratory approaches to diagnosis complicated comparisons between hospitals. To facilitate benchmarking and comparisons between institutions, we recommend development of a more standardized case definition.

scholarly journals Risk Factors for Acquisition of Clostridium difficile–Associated Diarrhea among Outpatients at a Cancer Hospital

2005 ◽  
Vol 26 (8) ◽  
pp. 680-684 ◽  
Author(s):  
Tara N. Palmore ◽  
SeJean Sohn ◽  
Sharp F. Malak ◽  
Janet Eagan ◽  
Kent A Sepkowitz
Keyword(s):  
Risk Factors ◽  
Clostridium Difficile ◽  
Case Control Study ◽  
Tertiary Care ◽  
Antibiotic Use ◽  
Generation Cephalosporin ◽  
Case Control ◽  
Cancer Center ◽  
Care Hospital ◽  
Control Study

AbstractBackground:Clostridium difficile-associated diarrhea (CDAD) is an important infection in hospital settings. Its impact on outpatient care has not been well defined.Objective:To examine risk factors of ambulatory cancer patients with CDAD.Design:Case-control study.Setting:Memorial Sloan-Kettering Cancer Center, a tertiary-care hospital.Methods:Cases of CDAD among oncology outpatients from January 1999 through December 2000 were identified via positive C. difficile toxin assay results on stool specimens sent from clinics or the emergency department. A 1:3 matched case-control study examined exposures associated with CDAD.Results:Forty-eight episodes of CDAD were identified in cancer outpatients. The mean age was 51 years; 44% were female. Forty-one (85%) had received antibiotics within 60 days of diagnosis, completing courses a median of 16.5 days prior to diagnosis. Case-patients received longer courses of first-generation cephalosporins (4.8 vs 3.2 days; P = .03) and fluoroquinolones (23.6 vs 8 days; P < .01) than did control-patients. Those receiving clindamycin were 3.9-fold more likely to develop CDAD (P < .01). For each additional day of clindamycin or third-generation cephalosporin exposure, patients were 1.29- and 1.26-fold more likely to develop CDAD (P < .01 and .04, respectively). The 38 CDAD patients hospitalized during the risk period (79.2%) spent more time as inpatients than did control-patients (19.3 vs 9.7 days; P <. 001).Conclusions:Antibiotic use, especially with cephalosporins and clindamycin, and prolonged hospitalization contributed to the development of CDAD. Outpatient CDAD appears to be most strongly related to inpatient exposures; reasons for the delayed development of symptoms are unknown.

Proposed Checklist of Hospital Interventions to Decrease the Incidence of Healthcare-Associated Clostridium difficile Infection

2009 ◽  
Vol 30 (11) ◽  
pp. 1062-1069 ◽  
Author(s):  
Sarah K. Abbett ◽  
Deborah S. Yokoe ◽  
Stuart R. Lipsitz ◽  
Angela M. Bader ◽  
William R. Berry ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Infection Control ◽  
Tertiary Care ◽  
Case Fatality ◽  
Incidence Rates ◽  
Environmental Services ◽  
Treatment Practices ◽  
Prevention And Treatment ◽  
Educational Campaign ◽  
Healthcare Associated

Background.The incidence and severity of Clostridium difficile infection (CDI) are increasing, and previously described interventions for controlling the spread of CDI are not easily generalized to multiple healthcare institutions.Objective.We tested prevention and treatment bundles to decrease the incidence of CDI and the mortality associated with CDI at our hospital.Design.Observational before-after study of adult patients admitted to a tertiary care, university-affiliated hospital during the period from January 2004 through December 2008.Methods.In January 2006, we launched an educational campaign and introduced a prevention bundle—a series of specific processes aimed at preventing the transmission of C. difficile among hospitalized patients, including enhanced isolation practices, laboratory notification procedures, and steps coordinating infection control and environmental services activities. In April 2006, we implemented a treatment bundle—a set of hospital-wide treatment practices aimed at minimizing the risk of serious CDI complications. We tracked quarterly incidence rates and case-fatality rates for healthcare-associated CDI cases at our hospital. Our main outcome was the healthcare-associated CDI incidence rate, measured as the number of healthcare-associated cases of CDI per 1,000 patient-days.Results.We followed patients for a total of 1,047,849 patient-days. The healthcare-associated CDI incidence rates fell from an average of 1.10 cases per 1,000 patient-days before intervention to 0.66 cases per 1,000 patient-days after intervention. This statistically significant decrease amounts to a 40% reduction in incidence after the intervention.Conclusions.Our intervention was successful in reducing the incidence of CDI at our hospital. On the basis of our experience, we propose the use of a checklist of hospital interventions to decrease the incidence of healthcare-associated CDI.

Healthcare associated infections caused by non-fermenting Gram negative rods (NFGNR): six years of experience of a tertiary hospital

2013 ◽  
Vol 7 (2) ◽  
pp. 06-12
Author(s):  
Zahidul Hasan ◽  
Md. Kamrul Islam ◽  
Arifa Hossain
Keyword(s):  
Blood Stream Infection ◽  
Tertiary Care ◽  
Blood Stream ◽  
Tertiary Hospital ◽  
Healthcare Associated Infections ◽  
Care Hospital ◽  
Gram Negative ◽  
Acinetobacter Spp ◽  
Tract Infections ◽  
Healthcare Associated

Recently non-fermenting Gram negative rods (NFGNR) are playing an important role in healthcare associated infections. This observational study in a tertiary care hospital of Dhaka city conducted during 01August 2007 to 30 June 2013 found that 34.8% isolated organisms from patients with healthcare associated infections were NFGNR. Majority (74.3 %) of these infections were occurring inside critical care areas. Pseudomonas and Acinetobacter together constituted 79.6% of the total NFGNR whereas Burkholderia cephacia complex (15.4%), Stenotrophomonas (4.3%) and Chryseobacterium species (0.7%) combined constituted remaining 20.4%. Out of total NFGNRs, Pseudomonas was responsible for highest number of catheter associated urinary tract infections (55.6%), ventilator associated pneumonia (46.3%), respiratory tract infection (65.8%) and surgical site infection (70.6%). Blood stream infection was predominantly caused by Burkholderia cephacia complex (33.5%) and Acinetobacter spp. (39.5%). Other than colistin most of the organisms were resistant to antibiotics commonly recommended for NFGNR.DOI: http://dx.doi.org/10.3329/bjmm.v7i2.19326 Bangladesh J Med Microbiol 2013; 07(02): 6-12

scholarly journals Providing safe care for patients in the coronavirus disease 2019 (COVID-19) era: A case series evaluating risk for hospital-associated COVID-19

2021 ◽  
pp. 1-7
Author(s):  
Elizabeth B. Habermann ◽  
Aaron J. Tande ◽  
Benjamin D. Pollock ◽  
Matthew R. Neville ◽  
Henry H. Ting ◽  
...  
Keyword(s):  
Hospital Stay ◽  
Tertiary Care ◽  
Case Series ◽  
Adult Patients ◽  
Care Hospital ◽  
Strict Adherence ◽  
Large Tertiary Care ◽  
Healthcare Associated ◽  
Serology Testing ◽  
Pcr Test

Abstract Objective: We evaluated the risk of patients contracting coronavirus disease 2019 (COVID-19) during their hospital stay to inform the safety of hospitalization for a non–COVID-19 indication during this pandemic. Methods: A case series of adult patients hospitalized for 2 or more nights from May 15 to June 15, 2020 at large tertiary-care hospital in the midwestern United States was reviewed. All patients were screened at admission with the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) polymerase chain reaction (PCR) test. Selected adult patients were also tested by IgG serology. After dismissal, patients with negative serology and PCR at admission were asked to undergo repeat serologic testing at 14–21 days after discharge. The primary outcome was healthcare-associated COVID-19 defined as a new positive SARS-CoV-2 PCR test on or after day 4 of hospital stay or within 7 days of hospital dismissal, or seroconversion in patients previously established as seronegative. Results: Of the 2,068 eligible adult patients, 1,778 (86.0%) completed admission PCR testing, while 1,339 (64.7%) also completed admission serology testing. Of the 1,310 (97.8%) who were both PCR and seronegative, 445 (34.0%) repeated postdischarge serology testing. No healthcare-associated COVID-19 cases were detected during the study period. Of 1,310 eligible PCR and seronegative adults, no patients tested PCR positive during hospital admission (95% confidence interval [CI], 0.0%–0.3%). Of the 445 (34.0%) who completed postdischarge serology testing, no patients seroconverted (0.0%; 95% CI, 0.0%–0.9%). Conclusion: We found low likelihood of hospital-associated COVID-19 with strict adherence to universal masking, physical distancing, and hand hygiene along with limited visitors and screening of admissions with PCR.

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