Abstract :
BACKGROUND/OBJECTIVES: Clostridium Difficile is a gram positive spore-forming rod that has been historically associated with antibiotic related diarrheas. This is the most common cause of Hospital Associated diarrhea – 3 million cases per year in the United States, adding up to $10,000 per case with an expected two week hospitalization stay.
Our hospital had been tracking the C-Difficile cases since October of 2003, averaging from 6-8 cases per month for our entire hospital, and the Newborn Intensive Care Unit (NICU) averaging one case every other month. Between July and August of 2005 our NICU reported 8 confirmed cases of C-diff. All infants were symptomatic and had positive toxin assays.
An investigation was launched to determine any possible commonalities among the infected infants. We found that all of the 8 infected infants had shared one of three beds in a corner of the NICU.
Our objective was to decrease the incidence of C-Difficile in the NICU through implementation of cleaning measures with diluted household bleach.
METHODS: A literature search was launched to find any related studies. The CDC website was referred to and a call was placed to the CDC to confirm the efficacy of our proposed cleaning. After confirming with the CDC that the use of bleach was the best method of cleaning open to us our environmental services cleaned the affected corner from top to bottom with a 1-10 bleach solution. All moveable items, rockers, screens, scales, etc., were also cleaned. We launched extensive staff education related to C-difficile and its ability to be found on environmental surfaces, in tandem with educating to the importance of washing hands with soap and water when you are caring for a patient with C-difficile.
RESULTS: The occurrences of C-difficile in the NICU have been drastically reduced. The cleaning was done in August of 2005, since that time there has not been one positive toxin assay for C-difficile in the NICU.
CONCLUSIONS: Outbreaks of C-difficile can be controlled with the CDC recommended disinfecting with bleach along with the implementation of hand washing with soap and water.
An incidence of C-difficile can cost $10,000 for the extended hospital stay; therefore by cleaning of environmental surfaces with bleach of known C-difficile patients, you can prevent transference of this organism to other patients, thus saving money, freeing up hospital space and decreasing cross-contamination.
