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J Am Coll Surg. 2019 Feb 7. pii: S1072-7515(19)30106-1. doi: 10.1016/j.jamcollsurg.2018.12.045. [Epub ahead of print]

Multidisciplinary Approach and 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 (CDI) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated an 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 CDI.

STUDY DESIGN:

Strategies to reduce CDI were reviewed from the literature and multi-disciplinary strategies were initiated. 1) Antimicrobial stewardship optimization of perioperative order sets to avoid cefoxitin and fluoroquinolone use was completed. Penicillin allergy assessment and skin testing was concomitantly implemented. 2) Increased use of ultraviolet (UV) disinfectant strategies for terminal cleaning of CDI patient rooms. 3) Increased hand-hygiene and PPE signage as well as monitoring in high-risk CDI areas. 4) improve diagnostic stewardship by an electronic best practice advisory to reduce inappropriate CDI testing. 5) Education through surgical grand rounds. 6) Routine data feedback via NSQIP and NHSN CDI reports.

RESULTS:

The observed rate of CDI decreased from 1.27% in 2016 to 0.91% in 2017. Cefoxitin and fluoroquinolone use decreased. CDI testing for patients on laxatives decreased. Terminal cleans with UV increased. Handwashing compliance increased. Data feedback to stakeholders was established.

CONCLUSIONS:

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

KEYWORDS:

Clostridium difficile; bundles; complications; infection prevention; multidisciplinary; postoperative outcomes

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