C. difficile rates plummet with implementation of preventive measures

A focused commitment to combatting C. difficile at the JGH has led to a steep drop in infection rates, thanks in large part to efforts spearheaded by the Department of Nursing.

Between 2012-2013 and 2014-2015, the rate fell well below the recommended provincial target, an improvement that is believed to have potentially saved approximately 17 lives and contributed to cost savings of more than $1 million.

According to Silvana Perna, Coordinator of Infection Prevention and Control at the JGH, the total number of C. difficile cases fell to 108 in 2014-2015, down substantially from 129 in 2013-2014 and from 282 in 2012-2013. This corresponds with a rate of 6.5 cases per 10,000 patient days in 2014-2015, a sharp decrease from the 16.3 cases per 10,000 patient days in 2012-2013, and considerably lower than Quebec’s target rate of 9.0.

Based on rates cited in the medical literature, Ms. Perna has estimated that the JGH’s preventive measures saved the lives of approximately 17 C. difficile patients in 2014-2015. Also using rates in the medical literature, she has calculated that the JGH spent $627,534 to cope with C. difficile in 2014-2015, a huge drop of 62 per cent—i.e., a cost savings of just over $1 million—compared to the $1,638,560 that was spent 2012-2013.

C. difficile has been a recurring problem since the mid-2000s in hospitals throughout Quebec and elsewhere in North America. When a patient is treated with antibiotics, many benign intestinal bacteria are unintentionally wiped out. C. difficile jumps in to fill this vacancy and, in the course of multiplying, releases a toxin that can sometimes be severe enough to lead to death.

The work of the Department of Nursing has been crucial in achieving these results, Ms. Perna says. Joanne Boileau, the Director of Nursing, along with the department’s Associate Directors, have shown “strong leadership in their commitment to reducing C. difficile infection rates.”

This has motivated nurses throughout the JGH, who come into regular and frequent contact with patients, and are in an ideal position to ensure that other members of staff and visitors observe preventive measures. These include putting on protective clothing and practicing proper hand hygiene on entering and leaving the patient’s room. Their involvement will be crucial in maintaining and reducing the lower infection levels.

Ms. Perna attributed the improvement to a combination of factors, stemming from an interdisciplinary approach that is essential in controlling C.difficile. The measures included:

• the use of hydrogen peroxide vapour to clean the rooms of difficile patients
• the hospital-wide use of Clorox wipes to clean surfaces in patients’ rooms
• cleaning all frequently touched surfaces in the rooms of difficile patients three times a day, instead of twice daily
• the purchase of equipment whose use is reserved for difficile patients
• continually sensitizing healthcare staff, managers and administrators to the importance of rigourously enforcing the preventive measures
• working with the JGH Pharmacy to provide certain patients with preventive medication when necessary
• ensuring that preventive steps are introduced and that rates are measured in strict accordance with guidelines developed by the Provincial Review of Nosocomial-Clostridium Difficile Infections. This committee, developed by Quebec’s Ministry of Health and Social Services, is headed by Dr. Yves Longtin, Chair of the JGH Infection Prevention and Control Committee.

“We’re delighted with these results, which could not have been achieved without the leadership of Nursing and the cooperation of staff from many departments and units,” Ms. Perna says. “But it’s also important for us not to let our guard down, because we’d really like to see these rates continue to fall even further.”