Infection control practices related to Clostridium difficile infection in acute care hospitals in Canada

doi:10.1016/j.ajic.2008.07.012

American Journal of Infection Control

Volume 37, Issue 1, February 2009, Pages 9-14

https://doi.org/10.1016/j.ajic.2008.07.012 Get rights and content

Background

We carried out a survey to identify the infection prevention and control practices in place in Canadian hospitals participating in the Canadian Nosocomial Infection Surveillance Program (CNISP).

Methods

An infection prevention and control practices survey was sent to CNISP hospitals at the beginning of November 2004, the same time that CNISP started a 6-month prospective surveillance for Clostridium difficile infection (CDI) to evaluate their infection prevention and control measures and laboratory methods for C difficile.

Results

A total of 33 hospitals completed and returned the survey. Infection control precautions were initiated in 18 hospitals (55%) due to the presence of a symptomatic patient before the C difficile laboratory tests were available. All of the hospitals used gloves and gowns as additional precautions. Twenty-three hospitals (70%) tested liquid stools based on a clinician's order, and 8 (24%) tested all liquid stools submitted whether of not C difficile testing was requested. The hospitals used 1 of 3 different products as a standard hospital-wide disinfectant; 24 (73%) used a quaternary ammonium compound, 8 (24%) used accelerated hydrogen peroxide, and 1 (3%) used a hypochlorite solution (1:10 bleach solution).

Conclusion

Although the hospitals used contact precautions quite uniformly, considerable variation was seen among hospitals in terms of testing strategies, cleaning and disinfection protocols and products, and isolation practices. The timing for the initiation of infection control precautions is important to prevent secondary transmission of CDI. Most of the hospitals implemented precautions while waiting for the toxin assay results.

Section snippets

Methods

CNISP is a collaborative effort of the Canadian Hospital Epidemiology Committee, a subcommittee of the Association of Medical Microbiology and Infectious Disease Canada and the Centre for Communicable Diseases and Infection Control of the Public Health Agency of Canada (PHAC). At the time of this survey, 41 sentinel hospitals from 9 provinces were participating in CNISP. All CNISP hospitals have a university affiliation and provide primary, secondary, and tertiary care to adult and/or pediatric

Results

A total of 34 acute care hospitals participated in the 6-month prospective surveillance for CDI. Of these, 33 completed the infection prevention and control practices survey. Of these hospitals, 19 (58%) were combined adult/pediatric hospitals, 10 (30%) were adult- only hospitals, and 4 (12%) were pediatric hospitals. The average size of the participating hospitals was 426 ± 267 beds (range, 76 to 1169 beds). Twenty-six hospitals (79%) had an infection control program in place with at least 1

Discussion

This report presents the findings of the first survey of infection prevention and control practices and laboratory methods used by Canadian acute care hospitals to control CDI. Although contact precautions were used quite uniformly in the 33 hospitals participating in the study, considerable variation was found in terms of testing strategies, cleaning and disinfection protocols and products, and isolation practices, even though a standardized case definition for CDI was used by all

References (35)

L.V. McFarland et al.
Implications for the changing face of Clostridium difficile disease for health care practitioners
Am J Infect Control
(2007)
T.D.I. Cartmill et al.
Management and control of a large outbreak of diarrhoea due to Clostridium difficile
J Hosp Infect
(1994)
M. Wilcox et al.
Isolation of patients with Clostridium difficile infection
J Hosp Infect
(1997)
S. Johnson et al.
Nosocomial Clostridium difficile colonisation and disease
Lancet
(1990)
L.V. McFarland
Epidemiology of infectious and iatrogenic nosocomial diarrhea in a cohort of general medicine patients
Am J Infect Control
(1995)
J.D. Siegel et al.
2007 guideline for insolation precautions. preventing transmission of infectious agents in healthcare settings
Am J Infect Control
(2007)
J. Perez et al.
Activity of selected oxidizing microbicides against the spores of Clostridium difficile: relevance to environmental control
Am J Infect Control
(2005)
F. Fitzpatrick et al.
Laboratory diagnosis of Clostridium difficile–associated disease in the Republic of Ireland: a survey of Irish microbiology laboratories
J Hosp Infect
(2008)
D.E. Zoutman et al.
The state of infection surveillance and control in Canadian acute care hospitals
Am J Infect Control
(2003)
S.M. Poutanen et al.
Clostridium difficile–associated diarrhea in adults
CMAJ
(2004)

C.P. Kelly et al.

Clostridium difficile infection

Annu Rev Med

(1998)

V.G. Loo et al.

Clostridium difficile: a formidable foe

CMAJ

(2004)

L.C. McDonald et al.

Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003

Emerg Infect Dis

(2006)

L. Valiquette et al.

Clostridium difficile infection in hospitals: a brewing storm

CMAJ

(2004)

M.D. Redelings et al.

Increase in Clostridium difficile–related Mortality Rates, United States, 1999–2004

Emerg Infect Dis

(2007)

T.J. Louie et al.

Clostridium difficile infection in hospitals: risk factors and responses

CMAJ

(2004)

J. Pepin et al.

Clostridium difficile–associated diarrhea in a region of Quebec from 1991–2003: a changing pattern of disease severity

CMAJ

(2004)

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Prevention of Clostridium difficile infection (CDI) remains challenging across the spectrum of health care. There are limited data on prevention practices for CDI in the rural health care setting.
An electronic survey was administered to 21 rural facilities in Wisconsin, part of the Rural Wisconsin Health Cooperative. Data were collected on hospital characteristics and practices to prevent endemic CDI.
Fifteen facilities responded (71%). Nearly all respondent facilities reported regular use of dedicated patient care items, use of gown and gloves, private patient rooms, hand hygiene, and room cleaning. Facilities in which the infection preventionist thought the support of his/her leadership to be “Very good” or “Excellent” employed significantly more CDI practices (13.3 ± 2.4 [standard deviation]) compared with infection preventionists who thought there was less support from leadership (9.8 ± 3.0, P = .033). Surveillance for CDI was highly variable. The most frequent barriers to implementation of CDI prevention practices included lack of adequate resources, lack of a physician champion, and difficulty keeping up with new recommendations.
Although most rural facilities in our survey reported using evidence-based practices for prevention of CDI, surveillance practices were highly variable, and data regarding the impact of these practices on CDI rates were limited. Future efforts that correlate CDI prevention initiatives and CDI incidence will help develop evidence-based practices in these resource-limited settings.
Understanding factors that impact on public and patient's risk perceptions and responses toward Clostridium difficile and other health care-associated infections: A structured literature review
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Clostridium difficile is the most common health care-associated infection and a major cause of death and increased morbidity. It is vital that patients and the public are provided with the right information and communication to assist them to understand their role in preventative measures. Successful implementation of communication and management strategies hinges on individuals’ risk perceptions.
We performed a structured literature review to examine the evidence regarding public and patients’ risk perceptions and responses toward Clostridium difficile and other health care-associated infections. Fourteen studies were included.
Only 1 study was specific to Clostridium difficile, and 7 were related to other health care-associated infections. Many reported limited understanding of the technical issues of the infection, concerns of transmission to family and friends, inadequate information available, and distrust. The media were one of the main sources of information. Both emotional and physical responses highlighted the level of confusion, fear, anxiety, and anger.
Empirical research of risk perceptions toward Clostridium difficile is limited. Without well-researched studies examining risk perceptions and responses, there is a danger of developing and implementing communication and management strategies that do not meet the needs of our patients or the public.
Wide variation in adoption of screening and infection control interventions for multidrug-resistant organisms: A national study
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We performed a survey of National Healthcare Safety Network hospitals in 2008 to describe adoption of screening and infection control policies aimed at multidrug-resistant organisms (MDRO) in intensive care units (ICUs) and identify predictors of their presence, monitoring, and implementation.
Four hundred forty-one infection control directors were surveyed using a modified Dillman technique. To explore differences in screening and infection control policies by setting characteristics, bivariate and multivariable logistic regression models were constructed.
In total, 250 hospitals participated (57% response rate). Study ICUs (n = 413) routinely screened for methicillin-resistant Staphylococcus aureus (59%); vancomycin-resistant Enterococcus (22%); multidrug-resistant, gram-negative rods (12%); and Clostridium difficile (11%). Directors reported ICU policies to screen all admissions for any MDRO (40%), screen periodically (27%), utilize presumptive isolation/contact precautions pending a screen (31%), and cohort colonized patients (42%). Several independent predictors of the presence and implementation of different interventions including mandatory reporting and teaching status were identified.
This study found wide variation in adoption of MDRO screening and infection control interventions, which may reflect differences in published recommendations or their interpretation. Further research is needed to provide additional insight on effective strategies and how best to promote compliance.
Infection prevention and control practices related to Clostridium difficile infection in Canadian acute and long-term care institutions
2011, American Journal of Infection Control
Clostridium difficile is an important pathogen in Canadian health care facilities, and infection prevention and control (IPC) practices are crucial to reducing C difficile infections (CDIs). We performed a cross-sectional study to identify CDI-related IPC practices in Canadian health care facilities.
A survey assessing facility characteristics, CDI testing strategies, CDI contact precautions, and antimicrobial stewardship programs was sent to Canadian health care facilities in February 2005.
Responses were received from 943 (33%) facilities. Acute care facilities were more likely than long-term care (P < .001) and mixed care facilities (P = .03) to submit liquid stools from all patients for CDI testing. Physician orders were required before testing for CDI in 394 long-term care facilities (66%)—significantly higher than the proportions in acute care (41%; P < .001) and mixed care sites (49%; P < .001). A total of 841 sites (93%) had an infection control manual, 639 (76%) of which contained CDI-specific guidelines. Antimicrobial stewardship programs were reported by 40 (29%) acute care facilities; 19 (54%) of these sites reported full enforcement of the program.
Canadian health care facilities have widely varying C difficile IPC practices. Opportunities exist for facilities to take a more active role in IPC policy development and implementation, as well as antimicrobial stewardship.
Would you like an infection with your injection? A study investigating infection control and administering policies regarding radiographer performed intravenous Injections
2009, European Journal of Radiography
Citation Excerpt :
In the authors opinion the increase in interventional procedures carried out in the radiography departmentincluding arteriograms, stent insertions, catheter placement in various organs may increase the risk of patient exposure to such pathogens leading to nosocomial infections. There are implications for healthcare staff as lapses in infection control practices have been associated with healthcare-acquired outbreaks of clostridium difficile [19]. This places the onus of responsibility of adhering to infection control practices on staff members in the healthcare environment.
This was a Study to Investigate Infection Control and Administering Policies Regarding Radiographer Performed Intravenous Injections. The hypotheses of the research study were:
radiographers did not follow best practice or departmental infection control guidelines relating to IV cannulation.
radiographers did not follow departmental IV administration guidelines.
Two methods of data collection were used, a literature review and an observational study including a pilot study. The qualitative research method used in order to gather data was a structured observational study of eight radiographers using a pre-prepared checklist based upon best practice guidelines from the Irish Institute of Radiography and Radiotherapy (IIRRT), and the infection control department of the hospital in which the study took place.
Each radiographer was observed several times and given a score accordingly with the results being presented in tabular form.
The research study ascertained that radiographers did not adhere to hospital infection control guidelines when inserting IV cannulae i.e. radiographers did not consistently wash their hands prior to performing IV cannulation.
Radiographers administering IV contrast media injections, did not fully adhere to IV administration guidelines.
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: Conflicts of interest: The authors report no conflicts of interest.

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Major ArticleInfection control practices related to Clostridium difficile infection in acute care hospitals in Canada

Background

Methods

Results

Conclusion

Section snippets

Methods

Results

Discussion

Am J Infect Control

J Hosp Infect

J Hosp Infect

Lancet

Am J Infect Control

Am J Infect Control

Am J Infect Control

J Hosp Infect

Am J Infect Control

Clostridium difficile–associated diarrhea in adults

CMAJ

Clostridium difficile infection

Annu Rev Med

Clostridium difficile: a formidable foe

CMAJ

Clostridium difficile infection in patients discharged from US short-stay hospitals, 1996–2003

Emerg Infect Dis

Clostridium difficile infection in hospitals: a brewing storm

CMAJ

Increase in Clostridium difficile–related Mortality Rates, United States, 1999–2004

Emerg Infect Dis

Clostridium difficile infection in hospitals: risk factors and responses

CMAJ

Clostridium difficile–associated diarrhea in a region of Quebec from 1991–2003: a changing pattern of disease severity

CMAJ

Major Article
Infection control practices related to Clostridium difficile infection in acute care hospitals in Canada