Multidisciplinary, multifaceted approach to C. difficile prevention - It works!

Clostridium difficile - bad.

Many good people doing a lot of good things to prevent C. difficile - Priceless

That's the basic summary of a recent report in The Joint Commission Journal on Quality and Patient Safety by Len Mermel and colleagues at Rhode Island Hospital. Faced with a high burden of CDI, they implemented a series of six "interventions" targeting C. difficile between 2006 and 2012.  These interventions were: (1) develop a C. difficile hospital infection control plan based on a risk assessment; (2) monitor hospitalwide morbidity and mortality associated with C. difficile infection; (3) improve sensitivity of C. difficile toxin detection in stool specimens using a PCR assay; (4) enhance environmental cleaning of patient rooms and equipment; (5) develop a C. difficile infection treatment plan; and (6) conduct other interventions including attempting antimicrobial stewardship.

Overall, the results were impressive with a 70% reduction in incidence. From a peak of 12.2 cases per 1000 discharges in 2006 rates fell to 3.6/1,000 discharges in 2012 with comparable declines in CDI-related mortality. Using time-series analysis they reported a change in slope of quarterly healthcare-associated CDI cases per 1000 discharges after each intervention, which you can see in the figure below. The slopes of each line are associated with (from left to right) the (1) pre-intervention period, (2) education, outcome reporting and room cleaning monitoring, (3) bleach product use for room cleaning, (4) PCR testing (5) additional room cleaning personal hired with defined responsibilities, (6) equipment cleaning training and monitoring.

Here is the link to the full text of the article (subscription required). Is it me or should Joint Commission's journal be open access in 2013?


  1. 70% reduction? Color me impressed!

  2. It's interesting how many public health problems are best dealt with using a variety of techniques. I was just reading an account of cholera and how the original approach involved isolation and an improved water supply. This worked somewhat, but it was the general sanitary engineering approach started in the mid-19th century, combining waste disposal, clean water, better nutrition, more effective quarantines, and the like, that turned cholera from a general plague into a rare illness. Modern drugs and hydration treatments are just the icing on the cake.

    Sure, there is sometimes a single magic bullet, like vaccination, that works, but most real solutions are multi-faceted.


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