Format

Send to

Choose Destination
J Am Coll Surg. 2019 Apr;228(4):570-580. doi: 10.1016/j.jamcollsurg.2018.12.045. Epub 2019 Feb 7.

Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients.

Author information

1
Department of Surgery, Duke University Medical Center, Durham, NC. Electronic address: Megan.Turner@duke.edu.
2
School of Medicine, Duke University Medical Center, Durham, NC.
3
Department of Surgery, Duke University Medical Center, Durham, NC.
4
Infection Prevention and Hospital Epidemiology, Duke University Medical Center, Durham, NC; Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC.
5
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC.
6
Duke Center for Antimicrobial Stewardship and Infection Prevention, Duke University Medical Center, Durham, NC; Department of Pharmacy, Duke University Medical Center, Durham, NC.
7
Performance Services, Duke Health, Durham, NC.

Abstract

BACKGROUND:

In 2017, our hospital was identified as a high outlier for postoperative Clostridium difficile infections (CDIs) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated a CDI task force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDIs.

STUDY DESIGN:

Strategies to reduce CDIs were reviewed from the literature and the following multidisciplinary strategies were initiated: antimicrobial stewardship optimization of perioperative order sets to avoid cefoxitin and fluoroquinolone use was completed; penicillin allergy assessment and skin testing were implemented concomitantly; increased use of ultraviolet disinfectant strategies for terminal cleaning of CDI patient rooms; increased hand hygiene and personal protection equipment signage, as well as monitoring in high-risk CDI areas; improved diagnostic stewardship by an electronic best practice advisory to reduce inappropriate CDI testing; education through surgical grand rounds; and routine data feedback via NSQIP and National Healthcare Safety Network CDI reports.

RESULTS:

The observed rate of CDIs decreased from 1.27% in 2016 to 0.91% in 2017. Cefoxitin and fluoroquinolone use decreased. Clostridium difficile infection testing for patients on laxatives decreased. Terminal cleaning with ultraviolet light increased. Handwashing compliance increased. Data feedback to stakeholders was established.

CONCLUSIONS:

Our multidisciplinary CDI reduction program has demonstrated significant reductions in CDIs. It is effective, straightforward to implement and monitor, and can be generalized to high-outlier institutions.

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center