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Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Published online by Cambridge University Press:  02 January 2015

Erik R. Dubberke ,
Dale N. Gerding ,
David Classen ,
Kathleen M. Arias ,
Kelly Podgorny ,
Deverick J. Anderson ,
Helen Burstin ,
David P. Calfee ,
Susan E. Coffin  and
Victoria Fraser
...Show all authors
Erik R. Dubberke
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Dale N. Gerding
Affiliation:
Loyola University Chicago Stritch School of Medicine, Chicago Hines Veterans Affairs Medical Center, Hines, Illinois
David Classen
Affiliation:
University of Utah, Salt Lake City
Kathleen M. Arias
Affiliation:
Association for Professionals in Infection Control and Epidemiology, Washington, D.C.
Kelly Podgorny
Affiliation:
Joint Commission, Oakbrook Terrace, Illinois
Deverick J. Anderson
Affiliation:
Duke University Medical Center, Durham, North Carolina
Helen Burstin
Affiliation:
National Quality Forum, Washington, D.C.
David P. Calfee
Affiliation:
Mount Sinai School of Medicine, New York, New York
Susan E. Coffin
Affiliation:
Children's Hospital of Philadelphia andUniversity of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
Victoria Fraser
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Frances A. Griffin
Affiliation:
Institute for Healthcare Improvement, Cambridge
Peter Gross
Affiliation:
Hackensack University Medical Center, Hackensack, New Jersey University of Medicine and Dentistry–New Jersey Medical School, Newark, New Jersey
Keith S. Kaye
Affiliation:
Duke University Medical Center, Durham, North Carolina
Michael Klompas
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
Evelyn Lo
Affiliation:
University of Manitoba, Winnipeg, Canada
Jonas Marschall
Affiliation:
Washington University School of Medicine, St. Louis, Missouri
Leonard A. Mermel
Affiliation:
Warren Alpert Medical School of Brown Universityand Rhode Island Hospital, Providence, Rhode Island
Lindsay Nicolle
Affiliation:
University of Manitoba, Winnipeg, Canada
David A. Pegues
Affiliation:
David Geffen School of Medicine at the University of California, Los Angeles
Trish M. Perl
Affiliation:
Johns Hopkins Medical Institutions and University, Baltimore, Maryland
Sanjay Saint
Affiliation:
Ann Arbor Veterans Affairs Medical Center and theUniversity of Michigan Medical School, Ann Arbor, Michigan
Cassandra D. Salgado
Affiliation:
Medical University of South Carolina, Charleston
Robert A. Weinstein
Affiliation:
Stroger (Cook County) Hospital and theRush University Medical Center, Chicago
Robert Wise
Affiliation:
Joint Commission, Oakbrook Terrace, Illinois
Deborah S. Yokoe
Affiliation:
Brigham and Women's Hospitaland Harvard Medical School, Boston, Massachusetts
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Extract

Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.

1. Increasing rates of CDI

C. difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections in the United States.

a. In the United States, the proportion of hospital discharges in which the patient received the International Classification of Diseases, Ninth Revision discharge diagnosis code for CDI more than doubled between 2000 and 2003, and CDI rates continued to increase in 2004 and 2005 (L. C. McDonald, MD, personal communication, July 2007). These increases have been seen in pediatric and adult populations, but elderly individuals have been disproportionately affected. CDI incidence has also increased in Canada and Europe.

b. There have been numerous reports of an increase in CDI severity.

c. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. This strain produces more toxins A and B in vitro than do many other strains of C. difficile, produces a third toxin (binary toxin), and is highly resistant to fluoroquinolones.

Type
SHEA/IDSA Practice Recommendations
Information
Infection Control & Hospital Epidemiology , Volume 29 , supplement S1: A Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals , October 2008 , pp. S81 - S92
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2008

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