1397. Reduction in the incidence of hospital-associated CDAD by means of the infection control interventions, not including antimicrobial use restrictions
Session: Poster Abstract Session: Clostridium difficile
Saturday, October 5, 2013
Room: The Moscone Center: Poster Hall C
Posters
  • Presentation number 1397 (abstract number 41365).pdf (76.4 kB)
  • Background: The exposure to antimicrobial agents and C.difficile are important to develop Clostridium difficile infection.  There may not be a single method that is effective in minimizing exposure to C. difficile and a multifaceted approach is usually required.

    Methods: We were monitoring the CDAD incidence departmentally from 1 April 2011 through 31 December 2011 (Pre-intervention period) in Wonkwang university hospital. The rate of CDAD in MICU was 5 times higher than the overall hospital rate.  The infection control interventions were performed in MICU from 1 April through 31 December 2012 (Intervention period). The infection control interventions consist of the education, isolation, hand hygiene, contact precautions, and environmental disinfection, but, not including the restriction of the antimicrobial agents use.

    Results: Patients characteristics such as mean age, length of the MICU stay, and APACHE- III score on MICU admission, were similar in both periods  The amount used of antimicrobial agents differed between both periods, the amount used of carbapenems and quinolones during intervention period was higher than that during preintervention period. During intervention period, the overall incidence of CDAD significantly increased from 0.93 to 1.17 cases/1,000 patient-days (P=0.021), but, the incidence of CDAD in MICU significantly decreased from 4.70 to 1.53 cases/1,000 patient-days (P= 0.012)(Table 1).

    Conclusion: In our study, a multifaceted approach including the education, isolation, hand hygiene, contact precautions, and environmental disinfection reduced the incidence of hospital associate CDAD without the restriction of antimicrobial use.

    Table 1. Demographic and clinical characteristic of patents admitted to MICU in both periods

    Characteristic

    Preintervention  (N=290)

    Intervention (N=277)

    p-value

    Age y, mean

    67.5

    66.9

    0.647

    Length of stay in ICU, days, mean

    14.0

    14.5

    0.760

    APACHE III score a, mean

    61.5

    61.7

    0.948

    Nasogastric tube insertion state (%)

    190 (65.5)

    200 (72.2)

    0.103

    CDAD in overall hospital

    0.93

    1.17

    0.021

    CDAD in MICU

    4.70

    1.53

    0.012

    The amount of received medicine (mg), mean

     

     

     

     Antibiotics

     

     

     

      3rd cephalosporins

    17684

    15489

    0.292

      Piperacillin/tazolactam

    91872

    64536

    0.063

      Carbapenems

    18371

    21821

    0.068

      Quinolones

    2694

    3761

    0.045

     Anti-ulcer drugs

     

     

     

      Proton pump inhibitors

    453

    546

    0.557

      H2 blockers

    480

    524

    0.574

    Jae Hoon Lee, MD/PhD, Infectious Disease, Wonkwang University Hospital/Infectioius Diseases, Iksan, South Korea, JiHyun Cho, Laboratory Medicine, Wonkwang University hospital, Iksan, South Korea and Eun Sung Yu, Wonkwang University Hospital, Iksan, South Korea

    Disclosures:

    J. H. Lee, None

    J. Cho, None

    E. S. Yu, None

    Findings in the abstracts are embargoed until 12:01 a.m. PST, Oct. 2nd with the exception of research findings presented at the IDWeek press conferences.