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28 Infection control management of Clostridium difficile infection (CDI) in an intensive care setting at king abdulaziz medical city/jeddah 2018
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  1. Areej Qudsi,
  2. Roxanne Taguas,
  3. Ang Seokgor,
  4. Javid Bhutta,
  5. Fahad Alhameed,
  6. Asim Alsaedi
  1. Infection Prevention and Control Department Ministry of National Guard Hospital Affairs

Abstract

Background Clostridium difficile is a gram-positive, anerobic, toxin-producing bacillus that mainly causes diarrhea and colitis. A recent meta-analysis reported an overall rate of 3.54 per 10,000 patient-days per year for C difficile infection (CDI). The highest incidence was observed in intensive care units (ICUs). In the USA, C difficile caused an estimated half a million infections and 29,000 deaths in 2012. More than 80% of these deaths occurred in individuals aged 65 years or older. The approximate cost of CDI treatment in the USA was US$ 5.4–6.3 billion per year. For the countries in the Arabian Peninsula including Jordan, Kuwait, Qatar, Saudi Arabia, Egypt, and Lebanon, the prevalence rates range from 4.6% to 23.6% for CDI isolates. Saudi Arabia has the lowest rate (4.6%) among these countries. A remarkable increase in nosocomial CDI cases in the adult ICU at King Abdulaziz Medical City was observed between 18 January and 11 March 2018.The aim of our study was to decrease the incidence of CDI in adult ICUs by implementing evidence-based interventions.

Methods Cluster investigations were done; a time, place, and person table created, brain storming to identify the possible risk factors was evoked by the investigative team, a root cause analysis/fishbone diagram was pulled, and corrective actions were formulated.

Clinicians: hand hygiene (soap and water), use of gloves, barrier precautions, prompt identification and early treatment of CDI cases were applied.

Environmental: proper cleaning, housekeeping protocol review, and types of disinfectants used were highlighted.

Surveillance: outcome surveillance of CDI cases was added to the patient safety annual report plan.

Administration: antibiotic stewardship program (ASP), managing staff shortage, and reinforcement of the guidelines were essential.

Results In the first quarter, the rate of CDI was 2.1 per 1000 patient-days, which dropped to 0.9, 0.4, and 0.4 per 1000 patient-days, respectively, in the second, third, and fourth quarters of 2018.

Conclusion There was a significant reduction in the number of CDI cases after timely and appropriate actions were taken. However, maintaining a zero rate was challenging. Continuous monitoring, ongoing data collection, and education were considered key to reducing CDI.

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