The Clostridium difficile rate at UHS has increased from 3.52 in 2010 to 5.40 in 2011. So far our YTD rate is 5.6. New York State’s rate is 7.83. The UHS Antibiotic Stewardship Committee has been reviewing each case of hospital acquired C. diff since December, 2011. Some key areas for practice improvement are:
- Early recognition for risk factors including, but not limited to, antibiotic use, immunosuppression, steroids, advanced age, prolong hospitalization and possibly the use of acid suppressors.
- Early identification of symptoms including greater than 3 stools in past 24 hours (other causes have been ruled out.
- Proper isolation precautions, gown and gloves, upon entering the room and washing hands with soap and water after exposure to the patient and their environment. The environment is cleaned with a chlorine 10% product.
- Confirm whether this is a first episode or recurrent.
- Evaluation of severity to include elevated WBC, number of stools per day, dehydration, fever, ileus, and hemodynamic stability.
- Antibiotic treatment is dependent on the severity of the illness. Remember that the oral Vanco or Metronidazole needs to be extended to 10 days after symptoms have abated or discontinuation of other antibiotics.
If you have questions, please feel free to contact any member of the committee, Dr. Fenlon, Dr Kandanati, Kathleen Wold, Infection Control Officer, or Linnette Beers, Pharmacy.