Prevention of Healthcare Associated Infections (Xenex Sponsored)

Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals

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Clostridium difficile Î Clostridium difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare- associated infections (HAIs) in the United States, more than doubling its incidence between 2000 and 2009. Î C. difficile infection (CDI) with onset outside the hospital may be more common than previously recognized, with ≥50% of CDIs having onset in the community. In addition, ≥75% of CDI cases have onset outside the acute care hospital. Î There have been numerous reports of an increase in CDI severity. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. Some studies have found that this strain produces more toxin A and B in vitro than most other strains of C. difficile, and it may produce more spores. It also produces a third toxin (binary toxin). BI/NAP1/027 is highly resistant to fluoroquinolones. Î CDI increases hospital length of stay by 2.8-5.5 days. Î In studies over the past 10 years, fluoroquinolones, previously infrequently associated with CDI, have been found to be primary precipitating antimicrobials. • Cephalosporins, ampicillin, and clindamycin remain important predisposing antibiotics. Î Gastric acid suppression has been recognized as a risk factor for CDI in some studies. Basic Practices for Prevention and Monitoring of CDI: Recommended for All Acute Care Hospitals Î Encourage appropriate use of antimicrobials (II). Î Use contact precautions for infected patients, single-patient room preferred (III for hand hygiene, II for gloves, III for gowns, III for single-patient room). Î Ensure cleaning and disinfection of equipment and the environment (III for equipment, III for environment). Î Implement a laboratory-based alert system to provide immediate notification to infection prevention and control (IPC) and clinical personnel about newly diagnosed CDI patients (III). Î Conduct CDI surveillance and analyze and report CDI data (III). Î Educate health care practitioners (HCPs), environmental service personnel, and hospital administration about CDI (III). 7

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