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Reduction of Clostridium difficile infection in a community-based hospital using hypochlorite solution
June 2005
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S Hayes J Gardner T Cahill Shriners Hospitals for Children, Cincinnati, Ohio BACKGROUND/OBJECTIVES: Ambulatory patients with tracheotomies carry a case that contains necessary suctioning supplies. The commercially obtained cases have nylon fabric inside and outside with various materials between the nylon, from plastics (sides) to chipboard (bottom), to give shape to the case. A case that was returned to our hospital respiratory department cultured positive for methicillin-resistant Staphylococcus aureus (MRSA) even after it had been cleaned (wiped off) with an FDA-approved phenolic disinfectant. The purpose of this study was to determine 1) the source of the MRSA and 2) how to provide a microbiologically safe case for the next patient. METHODS: An epidemiologic review of patient cultures plus pulsed-field gel electrophoresis (PFGE) of a number of MRSA isolates were used to determine the source of the MRSA. Repeated wiping with various detergents/ disinfectants still did not remove the MRSA from the case, which could not be immersed for cleaning because of the chipboard component of the case bottom. The garment fabrication department of our burn unit designed a case made of denim fabric with sides and bottom filled with a completely washable synthetic fiber to provide shape. The new cases were purposefully contaminated, washed (detergent with bleach) and dried in a regular clothes washer and dryer, then cultured using routine microbiologic technique. RESULTS: The epidemiologic and PFGE testing indicated that the MRSA was from the patient who had most recently used the case and that this patient had been colonized prior to use of the case. Contamination of the new denim case with the original MRSA, followed by washing and drying, resulted in a case that was free of the MRSA. The contamination, washing, and culturing were repeated for four other common pathogens in our hospital (Pseudomonas aeruginosa, Enterrococcus faecium, Acinetobacter sp, Klebsiella pneumoniae), and in each case the pathogen was removed by the routine laundering. Commercial cases cost $150 each, while our fabricated cases cost about $110. CONCLUSIONS: Commercially available cases for suctioning equipment can become contaminated with pathogens from the user and can subsequently be difficult to disinfect. Re-engineering the case, specifically making it out of totally washable materials, resulted in less expensive cases that can be readily disinfected.
Abstract ID 54641 Tuesday, June 21
Reduction of Clostridium difficile infection in a community-based hospital using hypochlorite solution D Lueckerath1 M Jones2 J Krettek1 R Little3 J Woodward1 1
Missouri Baptist Medical Center, St. Louis, Missouri BJC, St. Louis, Missouri 3 Washington University, St. Louis, Missouri 2
BACKGROUND/OBJECTIVES: This medical center (MC) is a 400-bed community-based hospital in suburban St. Louis County. There was concern that the incidence of C. difficile was increasing. Therefore, an intervention study was initiated to improve C. difficile rates. METHODS: A case was defined as a patient with diarrhea and +C. difficile > 48 hours after admission. In January 2004, the definition was expanded to include a patient with a + C. difficile on admission and who was an MC
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inpatient within the past 60 days. Daily and discharge cleaning of the C. difficile patient room with a 1:10 bleach solution was initiated. Rooms were to be cleaned daily with a 1:10 solution of bleach and water, using a different wiping cloth for each room. Staff was instructed to wipe down bedside rails, which is not usually done until discharge. Education on C. difficile, transmission, and prevention was delivered. The bleach intervention was piloted in two areas from August 2003 through January 2004, and disseminated housewide in February 2004. Housekeeping was informed to implement the bleach protocol by the designation of the letter ‘‘B’’ on the contact isolation sign outside the patient room. An e-mail was also sent to the housekeeping supervisors notifying them of new C. difficile patients. RESULTS: From February 2002 to January 2004, the C. difficile rate was 2.2 per 1000 patient days. Post bleach and education intervention, the rates decreased to 1.5 per 1000 patient days. The rate decline was statistically significant. (p=0.00007). CONCLUSIONS: The routine use of bleach cleaning in C. difficile rooms and education on preventing the transmission of C. difficile significantly decreased the C. difficile rate at MC.
Bioterrorism and Disaster Preparation Abstract ID 49821 Monday, June 20
Tularemia in New York City: When do we need to suspect bioterrorism? A Raimondi B Koll N Casau B Raucher J Protic Beth Israel Medical Center—Kings Highway Division, Brooklyn, New York ISSUE: Tularemia (Tu), known as rabbit fever, is a Category A agent of bioterrorism (BT). It was last seen in New York City (NYC) in 1998. This NYC medical center has been preparing for a BT event, and its emergency management preparedness program proved to be successful when a patient was admitted with Tu around the time of the Republican National Convention (RNC) being held in NYC. PROJECT: The medical center has been conducting nuclear, biologic and chemical (NBC) preparedness training since 2002 for all its healthcare workers (HCWs). The hospital emergency incident command system (HEIC) is used in the event of an emergency. NBC training provides education, communication, guidelines, and response plans to ensure safety and cooperation in the event of an attack. Our plan was tested when the diagnosis of Tu was made after the patient was discharged. RESULTS: A 20-year-old woman from Staten Island presented to the emergency department in August 2004 with an enlarged submandibular lymph node, pneumonia, and a pleural effusion. Pleural fluid and blood cultures grew gram-negative bacilli that were difficult to identify. Close cooperation with the NYC Department of Health identified the bacilli as Francisella tularensis. Because the case occurred around the time of the RNC and Tu is rare in NYC, there was concern as to whether this was a BT sentinel event. A thorough investigation revealed that the infection was naturally acquired. The patient’s dog had captured a wild rabbit and then licked the woman’s face. The woman survived, and no other cases were reported. Laboratory HCWs who handled the culture plates were contacted and evaluated for risk exposure. Antibiotic prophylaxis was deemed not necessary since specimens had not been handled by any HCW for almost 2 weeks. A fever watch was instituted and the laboratory HCWs were followed by employee health services. None developed any symptoms. LESSONS LEARNED: It is imperative to have an emergency plan in place. Our NBC training program allowed us to facilitate identification, apply precautions, alleviate fears, and communicate with all appropriate agencies in a
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S Hayes J Gardner T Cahill Shriners Hospitals for Children, Cincinnati, Ohio BACKGROUND/OBJECTIVES: Ambulatory patients with tracheotomies carry a case that contains necessary suctioning supplies. The commercially obtained cases have nylon fabric inside and outside with various materials between the nylon, from plastics (sides) to chipboard (bottom), to give shape to the case. A case that was returned to our hospital respiratory department cultured positive for methicillin-resistant Staphylococcus aureus (MRSA) even after it had been cleaned (wiped off) with an FDA-approved phenolic disinfectant. The purpose of this study was to determine 1) the source of the MRSA and 2) how to provide a microbiologically safe case for the next patient. METHODS: An epidemiologic review of patient cultures plus pulsed-field gel electrophoresis (PFGE) of a number of MRSA isolates were used to determine the source of the MRSA. Repeated wiping with various detergents/ disinfectants still did not remove the MRSA from the case, which could not be immersed for cleaning because of the chipboard component of the case bottom. The garment fabrication department of our burn unit designed a case made of denim fabric with sides and bottom filled with a completely washable synthetic fiber to provide shape. The new cases were purposefully contaminated, washed (detergent with bleach) and dried in a regular clothes washer and dryer, then cultured using routine microbiologic technique. RESULTS: The epidemiologic and PFGE testing indicated that the MRSA was from the patient who had most recently used the case and that this patient had been colonized prior to use of the case. Contamination of the new denim case with the original MRSA, followed by washing and drying, resulted in a case that was free of the MRSA. The contamination, washing, and culturing were repeated for four other common pathogens in our hospital (Pseudomonas aeruginosa, Enterrococcus faecium, Acinetobacter sp, Klebsiella pneumoniae), and in each case the pathogen was removed by the routine laundering. Commercial cases cost $150 each, while our fabricated cases cost about $110. CONCLUSIONS: Commercially available cases for suctioning equipment can become contaminated with pathogens from the user and can subsequently be difficult to disinfect. Re-engineering the case, specifically making it out of totally washable materials, resulted in less expensive cases that can be readily disinfected.
Abstract ID 54641 Tuesday, June 21
Reduction of Clostridium difficile infection in a community-based hospital using hypochlorite solution D Lueckerath1 M Jones2 J Krettek1 R Little3 J Woodward1 1
Missouri Baptist Medical Center, St. Louis, Missouri BJC, St. Louis, Missouri 3 Washington University, St. Louis, Missouri 2
BACKGROUND/OBJECTIVES: This medical center (MC) is a 400-bed community-based hospital in suburban St. Louis County. There was concern that the incidence of C. difficile was increasing. Therefore, an intervention study was initiated to improve C. difficile rates. METHODS: A case was defined as a patient with diarrhea and +C. difficile > 48 hours after admission. In January 2004, the definition was expanded to include a patient with a + C. difficile on admission and who was an MC
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inpatient within the past 60 days. Daily and discharge cleaning of the C. difficile patient room with a 1:10 bleach solution was initiated. Rooms were to be cleaned daily with a 1:10 solution of bleach and water, using a different wiping cloth for each room. Staff was instructed to wipe down bedside rails, which is not usually done until discharge. Education on C. difficile, transmission, and prevention was delivered. The bleach intervention was piloted in two areas from August 2003 through January 2004, and disseminated housewide in February 2004. Housekeeping was informed to implement the bleach protocol by the designation of the letter ‘‘B’’ on the contact isolation sign outside the patient room. An e-mail was also sent to the housekeeping supervisors notifying them of new C. difficile patients. RESULTS: From February 2002 to January 2004, the C. difficile rate was 2.2 per 1000 patient days. Post bleach and education intervention, the rates decreased to 1.5 per 1000 patient days. The rate decline was statistically significant. (p=0.00007). CONCLUSIONS: The routine use of bleach cleaning in C. difficile rooms and education on preventing the transmission of C. difficile significantly decreased the C. difficile rate at MC.
Bioterrorism and Disaster Preparation Abstract ID 49821 Monday, June 20
Tularemia in New York City: When do we need to suspect bioterrorism? A Raimondi B Koll N Casau B Raucher J Protic Beth Israel Medical Center—Kings Highway Division, Brooklyn, New York ISSUE: Tularemia (Tu), known as rabbit fever, is a Category A agent of bioterrorism (BT). It was last seen in New York City (NYC) in 1998. This NYC medical center has been preparing for a BT event, and its emergency management preparedness program proved to be successful when a patient was admitted with Tu around the time of the Republican National Convention (RNC) being held in NYC. PROJECT: The medical center has been conducting nuclear, biologic and chemical (NBC) preparedness training since 2002 for all its healthcare workers (HCWs). The hospital emergency incident command system (HEIC) is used in the event of an emergency. NBC training provides education, communication, guidelines, and response plans to ensure safety and cooperation in the event of an attack. Our plan was tested when the diagnosis of Tu was made after the patient was discharged. RESULTS: A 20-year-old woman from Staten Island presented to the emergency department in August 2004 with an enlarged submandibular lymph node, pneumonia, and a pleural effusion. Pleural fluid and blood cultures grew gram-negative bacilli that were difficult to identify. Close cooperation with the NYC Department of Health identified the bacilli as Francisella tularensis. Because the case occurred around the time of the RNC and Tu is rare in NYC, there was concern as to whether this was a BT sentinel event. A thorough investigation revealed that the infection was naturally acquired. The patient’s dog had captured a wild rabbit and then licked the woman’s face. The woman survived, and no other cases were reported. Laboratory HCWs who handled the culture plates were contacted and evaluated for risk exposure. Antibiotic prophylaxis was deemed not necessary since specimens had not been handled by any HCW for almost 2 weeks. A fever watch was instituted and the laboratory HCWs were followed by employee health services. None developed any symptoms. LESSONS LEARNED: It is imperative to have an emergency plan in place. Our NBC training program allowed us to facilitate identification, apply precautions, alleviate fears, and communicate with all appropriate agencies in a