Reducing the risk of healthcare associated Clostridium difficile infection by focusing on environmental interventions

Purpose:
Decrease healthcare associated Clostridium difficile infection housewide with special focus on the Transplant Surgical Service Inpatient Unit.

Significance:
By reducing the risk for infection we simultaneously reduced adverse affects for the patients such as skin breakdown, length of stay, prolonged antibiotic usage and potential complications such as dehydration, bowel perforation or toxic megacolon as a result of Clostridium difficile infection.

Strategy and Implementation:
The initial strategy was to review and evaluate existing practice as it related to the identification and placement of isolation needs, appropriate cleaning and disinfection of environmental and reusable patient care equipment, identification of surfaces for potential touch contamination for patient and staff, hand hygiene practices, identification and review of appropriate cleaning processes and the determination of the effectiveness of the cleaning process. The implementation design incorporated the needs of the patient at the center with a multi-collaborative approach from Nursing, Infection Prevention and Control, Environmental Services, Microbiology Lab, Biomed and Supply Logistics completing the design.

Evaluation:
The effectiveness of the innovative strategies was shown by a 2011 1st QTR baseline rate of 26.9, 2nd QTR rate of 18.98, 3rd QTR rate of 8.83 and a 4th QTR rate of 0.00 per 10,000 patient days. The 2012 1st QTR rate was 8.34, showing a 69% rate decrease for a 12 month period.

Implications for Practice:
Environmental awareness such hand hygiene, touch contamination education, cleaning of environmental surfaces and reusable patient care equipment, evaluation of environmental cleaning process for environmental and patient care team to reduce transmission risk of Clostridium difficile spores.