'Prevention is always preferable over control'
Doctor shares best practices on handling C. difficile in healthcare
Monday July 7, 2008 -- Natalie Miller
Prompt identification and appropriate surveillance are two elements in a toolkit healthcare providers can use to tackle one of the most common hospital-acquired infections, a doctor says.

C. difficile needs to be addressed as a bundle encompassing a number of interventions, says Dr. Mary Vearncombe of Sunnybrook Health Sciences Centre in Toronto who is chair of the Provincial Infectious Disease Advisory Committee's subcommittee on infection prevention and control.

“If you apply the C. difficile bundle of interventions instead of single interventions you'll get better results,” she says.

The best-practice approach to C. difficile or the 'bundle' includes: prompt identification and isolation of cases, laboratory testing, hand hygiene, environmental cleaning, antimicrobial stewardship and surveillance.

“Prevention is always preferable over control,” says Vearncombe.

“If we have to get to control, we've failed at some level.”

Vearncombe spoke during a live videoconference/web-cast on June 26 presented by the Ontario Hospital Association, the Ministry of Health and Long-Term Care and the Provincial Infectious Disease Advisory Committee. Healthcare providers from across the province tuned in for a rundown on C. difficile, how to prevent infection and the new reporting requirements of this growing problem in hospitals.

As of Sept. 30, 2008 all Ontario hospitals will be required to disclose C. difficile rates in their facilities through a public website. Hospitals will also be required to report specifically on outbreaks such as C. difficile to local public health units.

Vearncombe's presentation outlined 'the bundle' of best practices. On the point of prompt identification and isolation, she says hospitals need to empower front-line workers to act immediately, conduct daily surveillance and have appropriately-trained infection prevention and control staff. She says healthcare providers should not wait 24 hours or for lab reports to isolate a patient. “It's too late,” she says. “The horse has left the barn.”

She says while C. difficile is a normal environmental organism it colonizes in a small number of people and is the most common cause of diarrhea in hospitalized adults. And it's on the increase.

Once a person is isolated, care involves contact precautions even if C. difficile is not yet confirmed.

Secondly, managing C. difficile requires strong lab support, says Vearncombe. For instance, hospitals need to establish with their labs ahead of time a 24-hour turnaround. They also shouldn't rely on a single test for C. difficile diagnosis when two tests generate a 95 per cent accuracy rate. In addition, lab staff should report any positive results to infection prevention and control professionals immediately.

When preventing and managing C. difficile, hand hygiene is “extremely important,” she says. If soap and water isn't immediately available, use alcohol rub and don't use the patient's sink. Vearncombe says it's imperative education about hand hygiene is delivered to staff and patients as well.

Environmental cleaning is another crucial element. Vearncombe says hospitals should advise environmental services of all cases of C. difficile as they occur, ensure thorough cleaning of all horizontal surfaces and the patient's room twice daily with a hospital-grade disinfectant. She suggests periodic audits of the cleaning practices.

For the entire best practice guidelines, healthcare providers can look to the C. difficile document on the Ministry of Health and Long-Term Care website for more information.

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