Preventing Clostridium difficile infection

Clostridium difficile Initiative

The Clostridium difficile initiative works to assess, identify gaps, and prevent transmission of C. difficile infection (CDI) across different healthcare settings. We focus on 5 key domains to prevent infection and transmission of CDI and other multidrug-resistant organisms (MDROs):

1. Surveillance: Enroll facilities into the National Safety Network for Reporting
2. Best infection control practices: Identify opportunities to prevent transmission based on the facility's needs
3. Environmental hygiene: Implement or improve existing housekeeping and disinfection practices using observations and feedback
4. Antibiotic stewardship: Favor judicious use of antibiotics for common problems like asymptomatic bacteriuria
5. Interfacility transfer communication: Establish or strengthen facility communication about MDRO, CDI or other illnesses.

Basic Definitions

What is C. difficile?

Clostridium difficile is a bacteria that can cause diarrhea, abdominal pain, fever, bowel inflammation (colitis), and rarely severe colitis (“pseudomembranous colitis”) and bowel perforation. In its spore (inert) form, it survives heat and frost in the environment; C. difficile spores usually pass through our guts without harm. However, certain triggers, such as antibiotics or proton pump inhibitors, cause C. difficile to grow and produce toxins. These toxins cause the symptoms of diarrhea.

How is C. difficile spread?

C. difficile spores are spread on hands of sick patients and healthcare workers, and from surfaces and rooms that are not properly cleaned. Spores are not killed with typical disinfectants; so you need to use a fresh bleach solution (1:10 dilution) or special disinfectants. (EPA List K).

What is “healthcare-associated” C. difficile infection?

In an effort to address the causes of C. difficile infection (CDI), infections have been attributed to “healthcare-associated” vs. “community-associated.” Healthcare-associated C. difficile infections occur within 12 weeks of documented admission to a healthcare facility (e.g., hospital, nursing home, etc.); they account for 66% of CDI. These are further divided into healthcare- or community-onset, depending on where and when the person began having symptoms. Healthcare-associated cases are about evenly divided between hospital-onset, nursing home-onset, and other community-onset.

What is “community-associated” C. difficile infection?

C. difficile infections that occur without a history of admission to a healthcare facility in the last 12 weeks are considered community-associated, and account for about 33% of CDI.

Resources

Oregon

• CDI Toolkit (pdf): Complete document of education, FAQs, NHSN enrollment tools
• CDI presentation for Long-term Care Clinical Staff:(pdf): "Oregon Clostridium difficile Initiative: From spores to sporicidals"
• CDI presentation for Long-term care Frontline Staff (pdf): Oregon Clostridium difficile Initiative: essentials for bedside care
• CDI Frequently Asked Questions (FAQs) (pdf): Printable handout for staff, families, and patients
• HAI Outbreaks webpage: Guidelines for investigating an outbreak in a healthcare facility
• Partner letter/recruitment packet (pdf)
• 10 reasons to join a C. difficile initiative (pdf)
• C. difficile assessment tools for facilities (pdf): CDC tools (pilots) for facility baseline assessment, laboratory, and antibiotic stewardship programs for various healthcare settings.
• Oregon Interfacility Transfer Communication webpage: Rule definition, FAQs, form examples
• Oregon AWARE Antibiotic Stewardship Collaborative: Project to promote outpatient antibiotic stewardship through judicious use of antibiotics for common syndromes
• Oregon C. difficile Diseases A-Z page

CDC

• Get Smart Antibiotic Stewardship - Tools for outpatient antibiotic stewardship
• C. difficile Infection Overview
• C. difficile Resources for Facilities
• C. difficile Resources for Clinicians
• C. difficile Resources for Patients
• Tracking C. difficile infections

Control Measures

• SHEA: Clinical Practice Guidelines for Clostridium difficile in Adults
• APIC Guide to Preventing Clostridium difficile Infections
• Sporicidal EPA list for disinfection of C. difficile: EPA List K
• Interfacility transfer communication form to use when transferring a patient or resident with C. difficile infection

Data

Articles

• Lessa et al. NEJM. "Burden of Clostridium difficile infection in the United States (pdf) - Includes data from the Oregon study site)
• Emerging Infections Program (EIP) Clostridium difficile Oregon Population Surveillance Site
• Validation of 2012 CDI LabID Events from hospitals