New Expert Guidelines Aim to Focus Hospitals' Infectious Diarrhea Prevention Efforts

With rates of Clostridium difficile (C. difficile) now rivaling drug-resistant Methicillin-resistant Staphylococcus aureus (MRSA) as the most common bacteria to cause healthcare-associated infections, new expert guidance encourages healthcare institutions to implement and prioritize prevention efforts for this infectious diarrhea. The guidelines are published in the June issue of Infection Control and Hospital Epidemiology.

The new practice recommendations are a part of Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates, 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.

“The Compendium uses a data-driven approach to focus efforts on strategies most likely to be effective,” says Erik Dubberke, MD, MSPH, co-lead author. “Healthcare workers’ adherence to these recommendations is vital. Any weak link in the prevention chain can lead to excessive C. difficile cases.”

To help combat the highly infectious bacteria, experts recommend creating a multidisciplinary approach that enlists a broad scope of hospital personnel, including leadership, healthcare professionals, lab personnel, pharmacy technicians, environmental services staff, and IT professionals to collaborate and implement effective interventions. Below are recommended strategies for hospitals and other acute-care settings.

• Encourage appropriate antimicrobial use and stewardship. This includes both avoiding antimicrobial exposures if a patient does not require treatment and selecting antibiotics that pose a lower risk for developing C. difficile, when possible. This is distinct from a formal antimicrobial stewardship program, which remains a special approach to antibiotic use.
• Use contact precautions. Hospitals are urged to treat patients with C. difficile in separate rooms from the general patient population and require healthcare professionals to don gloves and gowns whenever providing care to someone with confirmed C. difficile. It is also recommended that healthcare professionals use dedicated patient care items and equipment in this care. 
• Practice hand hygiene. Because indirect transmission by healthcare professionals may be a major route by which patients acquire C. difficile, implementing protocol on hand hygiene is a crucial part of a successful prevention program. C. difficile differs from other drug-resistant bugs, such as MRSA and vancomycin-resistant Enterococcus (VRE) because it produces spores that are resistant to alcohol-based products. This makes wearing gloves and washing hands with soap and water before every encounter with infected patients extremely important. Hand hygiene protocols should be periodically measured to ensure compliance.
• Ensure environmental decontamination. Education of environmental support staff, including cleaning crews, is crucial to maintaining effective disinfection.. This includes proper cleaning of patient rooms and furnishings, equipment, and surfaces touched by healthcare professionals and patients.
• Conduct surveillance and performance measures. Implementing a laboratory-based alert system to provide immediate notification of newly diagnosed patients to clinical personnel will help frontline staff monitor for outbreaks. Additionally, creating reporting systems to capture the burden of the infection at a healthcare facility and assess efficacy of prevention interventions, such as hand hygiene and contact precaution, will help healthcare institutions to continually improve efforts.

The guidelines note several areas that require more research before making recommendations.
• Requiring use of gowns and gloves by family members and other visitors.
• Prescribing probiotics as a treatment against C. difficile.
• Using no touch disinfection technology.
• Restricting use of gastric acid suppressants.

The 2014 release updates the initial 2008 Compendium publication.

Reference: Erik Dubberke, Phillip Carling, Ruth Carrico, Curtis Donskey, Vivian Loo, Clifford McDonald, Lisa Maragakis, Thomas Sandora, David Weber, Deborah Yokoe, Dale Gerding. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update.  Infection Control and Hospital Epidemiology 35:6. June 2014.

Source:  Society for Healthcare Epidemiology of America (SHEA)