Hospital-wide Campaign Using Care Bundle to Control an Outbreak of Clostridium difficile Infection in Small and Medium Hospitals

Abstract

  The Clostridium difficile infection (CDI) rate increased from the baseline in our hospital (4 units, 180 bed, secondary care hospital) in June 2009. Despite compliance efforts for contact precautions, the CDI outbreak was not controlled. Therefore, we started infection control programs consisting of hospital-wide educational campaigns and care-bundles from April 2010. Educational campaigns were introduced for all hospital staff about CDI and the care-bundle at the beginning of the intervention. We started to implement hand washing with soap and water before and after each contact, and the use of gloves and aprons with patients with suspected CDI or any diarrhea. Patients with the diagnosis of CDI were isolated in single rooms or cohorts. Cleaning and disinfection of rooms used by patients with CDI was performed with 5000 ppm sodium hypochlorite solution. Thermometers, pulse oxymeters, sphygmomanometers, and stethoscopes were limited to single patient use. As a result, the incidence of CDI significantly decreased from mean 2.2 cases per 1000 patient-days in the preintervention period (August 2009 through March 2010) to 0.68 cases per 1000 patient-days in the postintervention period (July 2010 through January 2011). CDI rate decreases were observed in three of our four units. These findings confirm the effectiveness of hospital-wide campaigns using care-bundles to control an outbreak of CDI in small/medium hospitals.