Decreasing Clostridium difficile infections in surgery: impact of a practice bundle incorporating a resident rounding protocol

Abstract

Introduction: Clostridium difficile (CD) infection is a significant health problem. A new systems approach was introduced to reduce the risk of hospital-acquired CD infection (HA-CD) at our institution. We hypothesized that a practice bundle, including a protocol to limit patient exposures during house staff rounding, would decrease HA-CD infections.

Methods: Over a three-year period, 39,093 cases (17,145 inpatients) admitted to the surgical services were reviewed. Cases were reviewed for patient demographics, antibiotic exposures, compliance with antibiotic prophylaxis guidelines, and surgical infections. A resident rounding protocol was developed to limit patient exposures. The program bundle also included a hand washing initiative, maintaining gastric acidity, and antibiotic stewardship.

Results: After implementation of the bundle, the average monthly HA-CD infection rate in surgical patients decreased from 4.13 + 2.6 cases to 1.93 + 1.6 cases, p = 0.03. The overall rate of HA-CD infections for surgical cases decreased 41% from 2.8 cases/1,000 patient days to 1.8 cases/1,000 patient-days.

Conclusions: Bundled programs designed to reduce patient risk by controlling exposure to both environmental and carrier sources of CD can reduce hospital-acquired CD infections.