Evidence session on Clostridium Difficile
South Eastern Trust
Briefing Paper for the Health Committee on the practices in place in South Eastern Trust to address Clostridium difficile and the most up-to-date figures available (January – 15th February) on the number of cases of C difficile infection and the number of deaths where C difficile was recorded on the death certificate.
Background Information
Clostridium difficile presents in a wide range of symptoms, especially diarrhoea ranging from the mild to severe and those at most risk of contracting the condition are the elderly who have recently been on antibiotics and have some underlying illness or condition. The vast majority of patients recover very quickly. Clostridium Difficle is a recognised complication of antibiotic therapy in the frail elderly.
In 2007 the Trust admitted 43,000 patients. Within our Trust area we have one of the highest population growths in the 65+ age group in comparison with the rest of Northern Ireland. In addition to that the greatest rate of increase will be in the section of the population aged 85 years and over, which will see an increase of between 39% and 46% of the population (source NISRA) It is recognised that this particular age group i.e. over 65 years have increased susceptibility to C Difficile. A proportion of patients are admitted with symptoms which may subsequently be diagnosed as Clostridium difficile. The South Eastern Trust has a range of practices in place to reduce the spread of infection. The South Eastern Trust monitors each and every patient who presents with C.Difficile and they are appropriately managed within clearly defined and well established protocols
Practices in place to address Infection Prevention and Control
Cleanliness is a priority for the South Eastern Trust - in a very recent unannounced KMPG Audit as part of the Cleanliness Matters Strategy the South Eastern Trust scored very highly. The auditors scored the level of cleanliness at our hospitals higher than we scored ourselves.
An action plan is near completion to meet the infection reduction targets for April 2008/09.
The South Eastern Trust has in place a range of practical measures to prevent and minimise the risk of C.Difficile by
- The C difficile policy has been reviewed and updated to include a care pathway for all suspected and confirmed cases of Clostridium difficile. rsAny patient with Clostridium difficile as a primary diagnosis at the time of death has a Root Cause Analysis undertaken to determine if there are any lessons to be learnt
- Strict adherence to hand washing and monthly audit of hand washing
- All wards have alcohol hand rub at their entrances and at the patient bedside
- Antibiotic controls, e.g. Consultant only prescribing of certain antibiotics, antibiotic protocol
- Comprehensive antibiotic guidance for C Difficile is included in the Clostridium difficile Management Policy
- An Annual Infection Reduction Plan is kept under review by the Trust Board Lead Director for Infection Prevention & Control and at each meeting of the Infection Control Committee.
- Infection Prevention and Control is a monthly agenda item for Trust Board. C Difficile and MRSA rates are reported on a bi-monthly basis which is in the public domain
- Every clinical area within the Trust has an Infection Prevention and Control link nurse
- Orthopaedic Surgical Site Infection surveillance is undertaken with HISC
- The Trust works in partnership with relatives and carers on reducing the spread of infection through the Visitors Charter, information posters and one to one communication. Issues/concerns raised by patients and visitors are always taken very seriously
- It is our policy to ensure that in all cases the patients’ next of kin or identified carer are informed and are kept apprised of the condition of the patient.
- Restricted visiting for all outbreak areas
- An annual infection prevention and control training programme is delivered and is mandatory for all staff to attend
- All renovation projects and new builds are moving to predominantly single rooms to improve infection prevention, control, hygiene and privacy
- We have recruited a pharmacist who is about to take up post to work with clinical staff to promote safer prescribing of antibiotics
Management of a patient/clients care with suspected C Difficile
- All communication is open and transparent. Relatives/carers are informed of the diagnosis and of precautions to prevent spread of infection
- Patients known/suspected to have C difficile are located in a single room, where possible and preferably with en suite facilities until 48hours after diarrhoea has settled
- All suspected and confirmed cases of Clostridium difficile are immediately commenced on a care pathway to ensure best practice is followed throughout the Trust
- Samples are sent for laboratory testing for all patients/clients suspected of C Difficile
- Visiting is restricted
- Antibiotic prescriptions are reviewed with consultant microbiologist
- Transfers of symptomatic patients within the hospital are kept to a minimum
- If more than 3 cases are identified in one area within a 4 - 6 week period a full environmental clean is carried out
- If more than 3 cases are identified in one area within a 4 – 6 week period the ward is closed to all new admissions/transfers
Number of cases of C Difficile infection 1st January 2008 to 15th February 2008.
The South Eastern Trust does not have an outbreak of Clostridium Difficle. The numbers presented are as accurate as possible however they have not been validated and consequently should be treated with caution.
During the period 1st January to 15th February 2008 the South Eastern Trust had 26 confirmed cases of Clostridium difficile of these 8 are deceased and of these there was 1 primary cause of death and 1 secondary cause of death.
It should be noted that the individual with the primary cause had two other primary causes noted on the death certificate, Clostridium difficile was listed as third in priority.
