AHRQ Study Examines Ways to Greatly Reduce Presence of C. diff in Hospital Rooms

Applying a sequence of three interventions to clean and disinfect hospital rooms after the discharge of patients known to have Clostridium difficile infection (CDI) reduced positive cultures from those CDI rooms from 67 percent to 7 percent, according to an AHRQ-supported study published in the May issue of Infection Control and Hospital Epidemiology.The study evaluated the implementation of sequential cleaning and disinfection interventions during a 21-month period at a Veterans Affairs medical center. Starting at a baseline of 67 percent for positive cultures from CDI rooms, researchers found that providing education to environmental services personnel and the use of fluorescent markers to provide monitoring and feedback of the thoroughness of cleaning reduced the number of positive cultures to 57 percent. Adding automated ultraviolet radiation devices reduced positive cultures to 35 percent. When the facility also added a daily dedicated disinfection team with supervisory review, positive cultures were reduced to 7 percent. Select to access the PubMed® abstract of the study, titled “An Environmental Disinfection Odyssey: Evaluation of Sequential Interventions to Improve Disinfection of Clostridium difficile Isolation Rooms.”

2013 May;34(5):459-65. doi: 10.1086/670217.

An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms.

Sitzlar B, Deshpande A, Fertelli D, Kundrapu S, Sethi AK, Donskey CJ.

Source

Case Western Reserve University School of Medicine, Cleveland, Ohio.

Abstract

OBJECTIVE. Effective disinfection of hospital rooms after discharge of patients with Clostridium difficile infection (CDI) is necessary to prevent transmission. We evaluated the impact of sequential cleaning and disinfection interventions by culturing high-touch surfaces in CDI rooms after cleaning. DESIGN. Prospective intervention. SETTING. A Veterans Affairs hospital. INTERVENTIONS. During a 21-month period, 3 sequential tiered interventions were implemented: (1) fluorescent markers to provide monitoring and feedback on thoroughness of cleaning facility-wide, (2) addition of an automated ultraviolet radiation device for adjunctive disinfection of CDI rooms, and (3) enhanced standard disinfection of CDI rooms, including a dedicated daily disinfection team and implementation of a process requiring supervisory assessment and clearance of terminally cleaned CDI rooms. To determine the impact of the interventions, cultures were obtained from CDI rooms after cleaning and disinfection. RESULTS. The fluorescent marker intervention improved the thoroughness of cleaning of high-touch surfaces (from 47% to 81% marker removal; P < .0001). Relative to the baseline period, the prevalence of positive cultures from CDI rooms was reduced by 14% (P=.024), 48% (P <.001), and 89% (P=.006) with interventions 1, 2, and 3, respectively. During the baseline period, 67% of CDI rooms had positive cultures after disinfection, whereas during interventions periods 1, 2, and 3 the percentages of CDI rooms with positive cultures after disinfection were reduced to 57%, 35%, and 7%, respectively. CONCLUSIONS. An intervention that included formation of a dedicated daily disinfection team and implementation of a standardized process for clearing CDI rooms achieved consistent CDI room disinfection. Culturing of CDI rooms provides a valuable tool to drive improvements in environmental disinfection.