Clostridium difficile colitis: A retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy

• Published in: American journal of infection control 2010-09, Vol.38 (7), p.523-528
• Main Authors: Knight, Nicole, MD, Strait, Taylor, MD, Anthony, Nicholas, MD, Lovell, Roger, MD, Norton, H. James, PhD, Sautter, Robert, PhD, Scobey, Martin, MD
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Alcohol; alcohol-based hand hygiene; Alcohols - therapeutic use; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Bacterial infections; Biological and medical sciences; Clostridium difficile; Clostridium difficile - isolation & purification; Clostridium difficile-associated diarrhea; Colectomy - statistics & numerical data; Cross Infection - epidemiology; Cross Infection - microbiology; Cross Infection - pathology; Cross Infection - prevention & control; Diarrhea; Disease prevention; Disinfectants - therapeutic use; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - microbiology; Enterocolitis, Pseudomembranous - pathology; Enterocolitis, Pseudomembranous - prevention & control; Epidemiology. Vaccinations; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Hand Disinfection - methods; Hands; Health care policy; Health Policy; Health Services Research; Human bacterial diseases; Humans; Hygiene; Incidence; Infection Control; Infectious Disease; Infectious diseases; Medical sciences; Middle Aged; Mortality; Nosocomial infections; Organizational Policy; Other diseases. Semiology; Patients; Retrospective Studies; Sepsis - epidemiology; Stomach. Duodenum. Small intestine. Colon. Rectum. Anus; Young Adult
• ISSN: 0196-6553; 1527-3296
• DOI: 10.1016/j.ajic.2009.12.008

Background Clostridium difficile ‒associated diarrhea is a leading cause of hospital-acquired diarrhea. We sought to determine whether the institution of a hospital-wide alcohol-based hand rub (ABHR) policy was associated with an increase in the incidence and/or severity of health care facility‒onset, health care facility‒associated C difficile diarrhea (CDAD). Methods We used a retrospective chart review analysis to compare incidence rates of CDAD before and after implementation of the ABHR policy. We also compared rates of sepsis, colectomy, and death in patients with CDAD before and after implementation of the ABHR policy. Results The incidence rate of CDAD was 3.98 per 10,000 patient-days after implementation of the ABHR policy, compared with 4.96 per 10,000 patient-days before implementation ( P = .0036). The crude mortality rate in patients diagnosed with CDAD was 10.7% after implementation, compared with 13.3% before implementation ( P = .275). The rate of sepsis in patients diagnosed with CDAD was 19.6% after implementation, compared with 5.2% before implementation ( P < .0001). Conclusion Our data provide no evidence of an increased CDAD rate after implementation of an ABHR policy at our institution. The rate of sepsis in patients diagnosed with CDAD did rise, indicating increased severity of illness in patients with C difficile infection.