Decreasing Barriers in Prevention of Hospital‐Acquired Clostridium Difficile Colitis

1Kaiser Permanente Medical Center, Santa Clara, CA

Meeting: Hospital Medicine 2011, May 10-13, Dallas, Texas.

Abstract number: 82


Nearly all hospital‐acquired infections are preventable. There has been at least a twofold increase in hospital‐acquired Clostridium difficile–associated diarrhea (HA‐CDAD) across the country. Hospitalized patients with CDAD can have 3 times the length of stay and 4.5 times the death rate. CDAD is an enteric pathogen often seen in patients shortly after a course of antibiotics or in hospitalized patients. Spores can survive up to 70 days and be carried to another hospitalized patient. In our institution, we noticed multiple impedances to improving this situation such as confusing signage, unavailability of personal protective equipment (PPE), and ignorance regarding the inadequacies of alcohol gels.


Several measures were undertaken to decrease the rate of this infection, most importantly, an electronic educational module for all health care workers who have patient contact. This reiterated contact precautions with gown and gloves, soap and water for hand washing, and bleach for disinfecting. Any patient with possible infectious diarrhea had their own room with disposable stethoscope, pulse oximetry, and blood pressure cuff. There was a designated place in the room for PPE. There was nursing education to patient, family, and visitors. The precaution signage was changed to “CONTACT PLUS” precautions with simple pictorial instructions.


We measured the absolute number of new cases and number of cases/10,000 patient‐days before and after our interventions in 2 quarters of 2008 and compared them with postintervention corresponding quarters in 2009. The first 2 quarters were 13.8 and 13.3 in 2008, which went down to 9.18 and 8.00 in 2009 (postintervention), which was statistically significant (see Fig. 1).


Consistent and simplified standardized precautions significantly decreased the rate of HA‐CDAD infection in our institution. This study was able to decrease the incidence of HA‐CDAD in the face of a rapid, national increase. Probably the most important intervention was the brief educational module that was mandatory for all hospital employees with patient contact. Housekeeping learned that daily environmental cleaning with bleach was necessary. The previous confusing precaution signage was changed to a consistent color and was pictorial for easy reminders of gown, gloves, soap and water, and bleach. Early detection or suspicion of the possibility of HA‐CDAD helped prevent the spread by early isolation. Also readily available was disposable personal equipment. This decreased the chances of spread to other patients by fomites. The nursing education to visitors was also helpful. Previous antimicrobial therapy is a well‐established risk factor for HA‐CDAD and was not addressed in this study. Other challenges include human complacency. Our study highlights the extreme importance of education in getting all hospital health care workers on board with proper infection control to potentially significantly affect the incidence and spread of hospital‐acquired infections.


S. Mierendorf ‐ none; M. Rushton ‐ none

To cite this abstract:

Mierendorf S, Rushton M. Decreasing Barriers in Prevention of Hospital‐Acquired Clostridium Difficile Colitis. Abstract published at Hospital Medicine 2011, May 10-13, Dallas, Texas. Abstract 82. Journal of Hospital Medicine. 2011; 6 (suppl 2). Accessed April 3, 2020.

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