Reduction of C.difficile Cases in A Nursing Facility

Marjorie Wiltshire, RN; Sarah Simmons, DrPH; Charles Dale, BA; Mark Stibich, MHA, PhD; Julie Stachowiak, MIA, PhD. Morningside Ministries, San Antonio, TX. APIC 2015 Poster Presentation

71% reduction in UTI rates and 100% in skin infection rates, 54% drop in hospital readmissions from nursing home



The Effect of Pulsed Xenon Ultraviolet Disinfection and Enhanced Chemical Disinfection of Surfaces on Incidence and Recurrence of Clostridium difficile Cases within a Skilled Nursing Facility



The role of the environment in infection transmission in longterm care facilities may be greater than in acute care settings. Patient-to patient contact and extended length of stay add increased colonization pressure of common hospital associated pathogens, such as Clostridium difficile (C. difficile). Because patient rooms can be inhabited for weeks to months at a time, thorough disinfection remains a challenge for environmental services. With the goal of preventing hospital-acquired (HA) C. difficile infection and recurrence, a skilled nursing facility implemented pulsed xenon ultraviolet disinfection (PX-UV) in order to enhance environmental disinfection practices. Incident and recurrent C. difficile infection was defined using NHSN definitions. Three prevention programs were implemented: staff retraining on hand hygiene practices was conducted in June/July of 2014, followed by the implementation of sodium hypochlorite cleaning in August. No immediate change in infection rates were identified with these two interventions, so ultraviolet disinfection using a pulsed-xenon disinfection robot was added at the start of September 2014. PX-UV was performed in all isolation rooms on a daily basis, as well as in common areas. Bleach cleaning continued in isolation rooms daily, and at patient discharge. In the 8 month period prior to PX-UV implementation, the
number of HA-C. difficile cases was 30, with 22 of these being recurrences. Following the implementation of PX-UV, the number of HA-C. difficile cases was 8, with 5 being recurrences. This represents a statistically significant reduction of 76.8% (p=0.03). The success of this intervention could be a result of high environmental disinfection compliance, driven by the ease of integration of the PX-UV system and hypochlorite wipes by patients and staff into daily hospital operations within the long term care setting.


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