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ARTICLE

Preventing Clostridium difficile From Getting Loose

MAY 10, 2017 | AMANDA BINKLEY, PHARMD, AAHIVP, AND SHAWN BINKLEY, BS, PHARMD
On January 1, 2017, new antimicrobial stewardship standards were implemented that mandate the reporting of CDI in every hospital. As previously mentioned, appropriate antibiotic utilization has significantly decreased the rate of hospital-onset CDI. With the current increased incidence of CDI, the reporting rate is an important outcome to monitor.9 Indeed, the majority of acute care hospitals are already reporting the incidence of CDI to the Centers for Disease Control and Prevention’s National Healthcare Safety Network as part of the Centers for Medicare & Medicaid Services reporting program.
 
The best approach to combat CDI is a collaborative one that combines an antimicrobial stewardship program and infection control practices. The identification of patients with suspected CDI should occur rapidly, with contact isolation being implemented immediately. In addition, hand hygiene and disinfection of all surfaces in the patient’s room should be completed to prevention transmission of the infection.
 
Ultimately, prevention of CDI is key. Efforts should include early identification of patients with CDI, testing of patients who are symptomatic only, and infection-control measures—specifically, contact precautions, environmental cleaning, hand hygiene, and antimicrobial stewardship. We continue to see an increasing incidence of CDI with a high mortality rate. Required reporting will assist in alerting institutions to changes in their CDI rates to help prevent any future outbreaks.
 
Dr. Amanda Binkley earned her doctor of pharmacy degree at Philadelphia College of Pharmacy. She completed her PGY-1 pharmacy practice residency and PGY-2 infectious diseases residency at the Hospital of the University of Pennsylvania. She is an active member of the Society of Infectious Disease Pharmacists (SIDP).
 
Dr. Shawn Binkley earned his bachelor of science degree at Pennsylvania State University and his doctor of pharmacy degree at Midwestern University College of Pharmacy–Glendale, Arizona. He completed his PGY-1 pharmacy practice residency and PGY-2 infectious diseases residency at the Hospital of the University of Pennsylvania. He is an active member of SIDP.
 
References:
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  2. Centers for Disease Control and Prevention. Clostridium difficile infection. CDC website. www.cdc.gov/hai/organisms/cdiff/cdiff_infect.html. Updated March 1, 2016. Accessed February 17, 2017.
  3. Cohen SH, Gerding DN, Johnson S, et al; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31(5):431-455.
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  6. Muto CA, Blank MK, Marsh, JW, et al. Control of an outbreak of an infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive "bundle" approach. CID Infect Dis. 2007;45(10):1266-1273.
  7. Fowler S, Webber A, Cooper BS, et al. Successful use of feedback to improve antibiotic prescribing and reduce Clostridium difficile infection: a controlled interrupted time series. J Antimicrob Chemother. 2007;59(5):990-995.
  8. Carling P, Fung T, Killion A, Terrin N, Barza M. Favorable impact of a multidisciplinary antibiotic management program conducted during 7 years. Infect Control Hosp Epidemiol. 2003;24(9):699-706.
  9. Joint Commission. Approved: new antimicrobial stewardship standard. Jt Comm Perspect. 2016;36(7):1,3-4,8.


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