Hostname: page-component-78c5997874-dh8gc Total loading time: 0 Render date: 2024-11-14T04:23:47.150Z Has data issue: false hasContentIssue false
  • English
  • Français

Multipronged Intervention Strategy to Control an Outbreak of Clostridium difficile Infection (CDI) and Its Impact on the Rates of CDI from 2002 to 2007

Published online by Cambridge University Press:  02 January 2015

Karl Weiss ,
Annie Boisvert ,
Miguel Chagnon ,
Caroline Duchesne ,
Sylvie Habash ,
Yves Lepage ,
Julie Letourneau ,
Johanna Raty  and
Michel Savoie
Karl Weiss*
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Annie Boisvert
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Miguel Chagnon
Affiliation:
Maisonneuve-Rosemont Hospital, Faculty of Medicine, and the Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
Caroline Duchesne
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Sylvie Habash
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Yves Lepage
Affiliation:
Maisonneuve-Rosemont Hospital, Faculty of Medicine, and the Department of Mathematics and Statistics, University of Montreal, Montreal, Quebec, Canada
Julie Letourneau
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Johanna Raty
Affiliation:
Department of Infectious Diseases and Microbiology, Montreal, Quebec, Canada
Michel Savoie
Affiliation:
Department of Pharmacy, Montreal, Quebec, Canada
*
Maisonneuve-Rosemont Hospital, 5415 L'Assomption, Montreal, QC HIT 2M4, Canada (weisscan@aol.com)
Get access Rights & Permissions [Opens in a new window]

Abstract

Objective.

At the end of 2002, a new, more virulent strain of Clostridium difficile, designated BI/NAP1, was the cause of a massive outbreak of infection in the province of Quebec. This particular strain was associated with a dramatic increase in morbidity and mortality among affected patients in 2003–2004. We tested and implemented a multipronged infection control approach to curtail the rate of C. difficile infection (CDI).

Design.

Five-year observational study.

Setting.

A 554-bed, acute care tertiary hospital, the largest single medical center in Quebec, Canada.

Methods.

To curtail the magnitude of the outbreak, we implemented a global strategy consisting of rapid C. difficile testing for all hospitalized patients who had at least 1 occurrence of liquid stool, the rapid isolation of patients infected with C. difficile in a dedicated ward with a specially trained housekeeping team, a global hand hygiene program, and the hiring of infection control practitioners. Antibiotic consumption at the institutional level was also monitored during the 5-year surveillance period. Cases of hospital-acquired CDI per 1,000 admissions were continuously monitored on a monthly basis during the entire surveillance period.

Results.

The highest recorded CDI rate was 42 cases per 1,000 admissions in January 2004. Once additional infection control resources were put in place, the rate descreased significantly during the period from April 2005 to March 2007. During the 2003–2004 period, there were 762 cases of CDI (mean annual rate, 37.28 cases per 1,000 admissions) recorded in our study, compared with 292 cases of CDI (14.48 cases per 1,000 admissions) during the 2006–2007 period (OR, 0.379 [95% CI, 0.331–0.435]; P < .001 ), a 61% reduction. In March 2007, the equivalent of 4 full-time equivalent infection control practitioners were in place, which gave a ratio of 0.96 infection control practitioners per 133 beds in use, compared with the ratio of 0.24 infection control practitioners per 133 beds in use in 2003, and the total number of hours dedicated to cleaning and housekeeping increased by 26.2%. The total amount of antibiotics used in the hospital did not vary significantly from 2002 to 2007, although there were changes in the classes antibiotic used.

Conclusion.

The implementation of a multipronged intervention strategy to control the outbreak of CDI significantly improved the overall situation at the hospital and underlined the importance of investing in stringent infection control practices.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 30 , Issue 2 , February 2009 , pp. 156 - 162
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1.McDonald, LC, Owings, M, Jernigan, DB. Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003. Emerg Infect Dis 2006;12:409–415.CrossRefGoogle ScholarPubMed
2.Kyne, L, Hamel, MB, Polavaram, L, Kelly, CP. Health care costs and mortality associated with nosocomial diarrhea due to Clostridium difficile. Clin Infect Dis 2002;34:346–353.Google Scholar
3.Loo, VG, Poirier, L, Miller, MA, et al.A predominantly clonal multi-institutional outbreak of Clostridium difficile-associated diarrhea with high morbidity and mortality. N Engl J Med 2005;353:2442–2449.Google Scholar
4.Poutanen, SM, Simor, AE. Clostridium difficile-associated diarrhea in adults. CMAJ 2004;171:51–58.Google Scholar
5.Institut National de Santé Publique. Surveillance des diarrhées associées à Clostridium difficile au Québec. Juin 2005. Available at: http://www.inspq.qc.ca/pdf/publications/389-SurveillanceCDifficile_Bilan22aout04 -31mars05.pdf. Accessed December 19, 2008.Google Scholar
6.Eggertson, L, Sibbald, B. Hospitals battling outbreaks of C. difficile. CMAJ 2004;171:19–21.CrossRefGoogle ScholarPubMed
7.Pepin, J, Valiquette, L, Alary, ME, et al.Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004;171:466–472.CrossRefGoogle Scholar
8.Eggertson, L. C. difficile strain 20 times more virulent. CMAJ 2005;172:1279.Google ScholarPubMed
9.Pepin, I, Saheb, N, Coulombe, MA, et al.Emergence of fluoroquinolones as the predominant risk factor for Clostridium difficile-associated diarrhea: a cohort study during an epidemic in Quebec. Clin Infect Dis 2005;41:1254–1260.CrossRefGoogle ScholarPubMed
10.Weiss, K, Bergeron, L, Bernatchez, H, Goyette, M, Savoie, M, Thirion, D. Clostridium difficile-associated diarrhoea rates and global antibiotic consumption in five Quebec institutions from 2001 to 2004. Int J Antimicrob Agents 2007;30:309–314.Google Scholar
11.WHO Collaborating Centre for Drug Statistics Methodology. Last updated August 11, 2008. Available at: http://www.whocc.no/atcddd. Accessed December 19, 2008.Google Scholar
12.Conseil du médicament. Gouvernement du Québec, 2008. Available at: http://www.cdm.gouv.qc.ca. Accessed December 3, 2008.Google Scholar
13.Institut National de Santé Publique. Surveillance des diarrhées à Clostridium difficile au Québec. Février 2006. Available at: http://www.inspq.qc.ca/pdf/publications/470-BilanCdifficile-21aout2005-10decembre2005.pdf. Accessed December 19, 2008.Google Scholar
14.Institut National de Santé Publique. La surveillance des diarrhées associées aux infections à Clostridium difficile: deuxième rapport tiré du système de surveillance des infections à Clostridium difficile (SSICD) de l’Institut National de Santé Publique du Quebec. Quebec City, April 2005. Available at: http://publications.msss.gouv.qc.ca/acrobat/f/documentation/2005/05-209-01.pdf. Accessed December 19, 2008.Google Scholar
15.Eggertson, L. Quebec puts up 20 million dollars for C difficile fight. CMAJ 2005;172:622.Google Scholar
16.Weiss, K. Poor infection control, not fluoroquinolones, likely to be primary cause of Clostridium difficile-associated diarrhea outbreaks in Quebec. Clin Infect Dis 2006;42:725–727.CrossRefGoogle Scholar
17.Beaulieu, M, Thirion, DJG, Williamson, D, Pichette, G. Clostridium difficile-associated diarrhea outbreaks: the name of the game is isolation and cleaning. Clin Infect Dis 2006;42:725.Google Scholar
18.Simor, AE, Bradley, SF, Strausbaugh, LJ, Crossley, K, Nicolle, LE; SHEA Long-Term-Care Committee. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol 2002;23:696–703.CrossRefGoogle ScholarPubMed
19.Johnson, S, Gerding, DN, Olson, MM, et al.Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88:137–140.CrossRefGoogle ScholarPubMed
20.Gerding, DN, Johnson, S, Peterson, LR, Mulligan, ME, Silva, J Jr. Clostridium difficile-associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.Google Scholar
21.Zafar, AB, Gaydos, LA, Furlong, WB, et al.Effectiveness of infection control program in controlling nosocomial Clostridium difficile. Am J Infect Control 1998;26:588–593.Google Scholar
22.Thomas, C, Stevenson, M, Riley, TV. Antibiotics and hospital-acquired Clostridium difficile-associated diarrhoea: a systematic review. J Antimicrob Chemother 2003;51:1139–1150.Google Scholar
23.Muto, CA, Blank, MK, Marsh, JW, et al.Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis 2007;45:1266–1273.Google Scholar