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New guidelines focus on prevention of C. difficile in health care settings
An update to the 2008 Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals includes new guidelines for health care institutions regarding prevention of drug-resistant Clostridium difficile.
Rates of C. difficile have surpassed those of methicillin-resistant Staphylococcus aureus, indicating it is the most common bacteria to cause health care-associated infections, according to a press release.
Erik Dubberke, MD, MSPH, of the Washington University School of Medicine, St. Louis, is a co-author of the guidelines, which are a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology and The Joint Commission.
Erik Dubberke
The guidelines suggest a multidisciplinary approach that requires efforts from all hospital personnel. The recommendations include:
- Appropriate antimicrobial use and stewardship. If a patient does not require treatment, they should avoid antimicrobial exposure and clinicians should choose antibiotics with a lower risk for C. difficile;
- Contact precautions such as treating patients for C. difficile in separate rooms from the general patient population, clinicians wearing gloves and gowns when treating patients for C. difficile, and patient care equipment dedicated for use among patients with C. difficile;
- Practicing good hand hygiene;
- The education of environmental support staff, including cleaning crews, on the proper cleaning of patient rooms, equipment, and surfaces touched by clinicians and patients;
- Implementation of a laboratory-based alert system that notifies clinical personnel of newly diagnosed patients;
- Creating reporting systems to assess the burden of infection in an institution and evaluate efficacy of prevention interventions, so that healthcare institutions can continually improve their efforts.
The authors of the guidelines note that the following areas require more research before recommendations can be made: the use of gowns and gloves by family members and visitors, probiotics as a form of treatment for C. difficile, no-touch disinfection technology, and restricting use of gastric acid suppressants.
“The compendium uses a data-driven approach to focus efforts on strategies most likely to be effective. Health care workers’ adherence to these recommendations is vital. Any weak link in the prevention chain can lead to excessive C. difficile cases,” Dubberke said in the release.