Table 3. Summary of Recommendations to Prevent CDI (cont'd)
5. Assess the adequacy of room cleaning. (L)
a. Work with the environmental services team to establish a process for assessing
adequacy of room cleaning at a frequency that is feasible for the team.
b. Review and improve cleaning/disinfection techniques, including : proper dilution
of cleaning/disinfection products, adequacy of cleaning/disinfection technique,
cleaning "high-touch" surfaces, frequency of changing rags/mop water, and
movement from "clean" areas to "dirty" areas.
c. Consider environmental decontamination with an US Environmental Protection
Agency (EPA)-approved sporicidal agent if room cleaning/disinfection is deemed
to be adequate but there is ongoing C. difficile transmission.
6. Implement a laboratory-based alert system to provide immediate notification to
infection preventionists and clinical personnel about newly diagnosed patients with
CDI. (L)
a. To place patients with CDI on contact precautions in a timely manner, develop
an alert system among the laboratory, infection preventionists, and the clinical
personnel caring for the patient.
b. Options that push notifications to those HCP who need to act on the information
immediately are preferred, such as phone call and pager alerts or automated secure
electronic alerts. The alert system should not rely solely on passive communications
that may delay receipt of results, such as faxes or emails to infrequently monitored
inboxes.
c. Alert patient care areas of positive test results immediately so that these patients can
be placed on contact precautions as soon as possible.
d. When a patient has CDI (or another current or prior infection requiring isolation),
communicate the CDI/isolation status when transferring the patient to another
healthcare facility so appropriate precautions can be implemented at the accepting
facility.
7. Conduct CDI surveillance and analyze and report CDI data. (H)
a. At a minimum, calculate healthcare facility-onset CDI rates at the organizational
level and consider specifically calculating CDI rates by unit or ward. (Table 1)
b. Provide CDI rates and CDI prevention process measures to key stakeholders
including senior leadership, physicians, nursing staff, and other clinicians.
c. Provide the process and outcome measures to appropriate hospital staff and
administrators on a regular basis.
8. Educate HCP, environmental service personnel, and hospital staff, and administrators
about CDI. (L)
a. Include risk factors, routes of transmission, local CDI epidemiolog y, patient
outcomes, and treatment and prevention measures.
