Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Abstract

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 CDIC. 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.

Clostridium difficile Infection in Infants and Children

“…15 In the setting of a high prevalence of asymptomatic carriage, detection of C difficile toxin cannot be assumed to be the causative agent for diarrhea in children before adolescence, particularly young children. 16 The NAP1 Isolate of C difficile…”

Infection Prevention and Control in Residential Facilities for Pediatric Patients and Their Families

“…29 " 31 C. difficile is one of the most frequent infections acquired by individuals within the healthcare setting. 29 When infection does occur, C. difficile most often leads to colitis (ie, inflammation of the large intestine), manifested as fever, abdominal pain and/or cramping, and diarrhea with or without blood. 31 C. difficile colitis occurs most often in hospitalized patients receiving antibiotics, other medications such as chemotherapy, or surgery, although it can also occur in individuals without risk factors.…”

Laboratory Diagnosis of Clostridium difficile Infection

“…20 Spore production, which varies among strains of C. difficile, 21 enhances the ability of the organism to spread among hospitalized patients. 22 Some strains of C. difficile appear to have enhanced capability for spreading and causing outbreaks.…”