341. A System-Wide Reduction in the Incidence of C. difficile and MDROs due to an Infection Prevention & Control Bundle
Session: Poster Abstract Session: Clostridium difficile - Epidemiology, Diagnosis, Treatment, and Prevention
Friday, October 21, 2011
Room: Poster Hall B1
Background: Wellstar consists of 5 hospitals ranging from 630 to 50 beds. The transmission of C. difficile and multidrug-resistant organisms (MDROs) is known to be multifactorial.  We evaluated the impact of a prevention/control bundle on C. difficile and MDRO incidence.  

Methods: “Bundle” tactics were introduced system-wide in February 2009 focused on reducing transmission with early detection & screening of symptoms, improving contact precautions & hand hygiene compliance, enhancing environmental cleaning, improving antimicrobial stewardship & using treatment algorithms all supported by a system-wide change management/performance improvement structure. Hydrogen peroxide vapor (HPV) decontamination was introduced at the two largest hospitals in the system, Kennestone (630 bed acute care facility) from June 2009 & Cobb (310 bed acute care facility) hospitals from Dec. 2009.  HPV decontamination was performed on entire units at the start of the deployment at Kennestone and then on the rooms of patients with C. difficile and MDROs following their discharge & in operating rooms, GI laboratories & catheterization laboratories after they were used to treat patients with C. difficile & on a scheduled basis. A new antimicrobial stewardship program for C. difficile cases began in January 2010: all cases were reviewed in order to stop therapy sooner. We examined the incidence of healthcare-associated C. difficile, methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant enterococci (VRE) infection from April 2008-Jan 2009 (before the interventions began) compared with February 2009-October 2010.  

Results: The incidence of C. difficile, MRSA & VRE was 2.3, 0.71 & 0.38 cases per 1000 patient days, respectively, before the bundle of interventions & 1.5, 0.64 & 0.26 cases per 1000 patient days, respectively, during the bundle intervention period (C. difficile incidence rate ratio, IRR =0.64, p<0.0001; MRSA IRR=0.89, p=0.25; VRE IRR=0.32, p=0.01).

Conclusion: The incidence of healthcare-associated C. difficile, MRSA & VRE has fallen due to the introduction of a bundle of infection prevention & control measures. Since interventions were introduced concurrently, it is not possible to determine the relative benefit of each intervention.

Subject Category: N. Hospital-acquired and surgical infections, infection control, and health outcomes including general public health and health services research

Marcia Delk, M.D., MBA1, Robert Jansen, M.D., MBA1, Lisa Oakley, M.D.2 and Thomas Sheftel, M.D.3, (1)Senior Leadership, Administration, WellStar Health System, Marietta, GA, (2)WellStar Health System, Marietta, GA, (3)WellStar Medical Group, WellStar Health System, Marietta, GA


M. Delk, None

R. Jansen, None

L. Oakley, None

T. Sheftel, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.