Title : Control of C. difficile-associated disease using a Multimodal Intervention
Clostridioides difficile has been recognized as the most common cause of hospital-acquired diarrhoea. The symptoms vary from mild diarrhoea to fulminating infection, leading to pseudomembranous colitis and death. Since 2003, C. difficile-associated disease (CDAD) has been a part of mandatory surveillance in the UK; mandatory surveillance in Northern Ireland was introduced in 2004. The UK Department of Health has published guidelines on the control of CDAD and has also developed a ‘care bundle’ to reduce the risk of acquiring C. difficile.
Since 2008, The Southern Health & Social Care Trust (SHSCT) noticed a rise in the number of new cases of CDAD. As a result, our trust’s infection prevention control and senior management team developed a comprehensive intervention plan which included early diagnosis, prompt isolation of all patients with diarrhoea in a single room or cohort ward, implementation of contact precautions with a campaign to promote hand hygiene, implementation of an antibiotic stewardship programme, education and training of all clinical staff, enhanced environmental cleaning with compliance monitoring, enhanced surveillance and feedback via an e-dashboard and root cause analysis for all patients.
Implementing a multimodal intervention strategy has proven very effective. We have since noted a reduction in the incidence of C. difficile cases from February 2009 onwards in all the healthcare facilities within the SHSCT, both in hospital and community cases. Following the intervention, the reduction of CDAD fell in patients aged ≥65 years from 164 cases in 2008-09 to 37 cases in 2009-10, a reduction of 77% within one year. However, what was particularly notable was that following the intervention, we started to see a reduction in CDAD after six weeks, and a 65% reduction in cases which continued till 2021/2022 (Fig 1). In conclusion, it is possible to reduce hospital-cquired CDAD via the implementation of a multimodal intervention strategy.