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c diff

Members of the C. diff Charter Team include, back row (l-r): Jeffrey Topal, MD; Melissa Debies-Carl, operations manager, Environmental Services; Janet Kozakiewicz, PharmD; Aram Berberian, RN; Maribeth Cabie, PharmD; Michael Aniskiewicz, infection preventionist; Scott Sussman, MD; and Richard Martinello, MD. Front row (l-r) are: Sara Cohn, PharmD; Michelle Whitbread, quality improvement coordinator; and Jill Williams, RN. Missing from photo: Patricia Brown, RN; Heather Cherry, RN; Marie Landry, MD; Anthony Anderson, PharmD; Lauren Wagner, Pharm D; and David Peaper, MD.

In just one year, it caused nearly half a million infections in patients in the United States, according to the Centers for Disease Control and Prevention. A CDC study found that one out of every nine patients age 65 or older died within 30 days of diagnosis.

These are some of the reasons Yale New Haven Hospital has launched an effort to prevent the spread of the Clostridium difficile (C. diff) bacterium, which can cause diarrhea and colon inflammation that can range from mild to life-threatening. Reducing C. diff and other types of hospital-acquired infections is a YNHH 2015-2016 Performance Incentive Plan (PIP) goal.

"C. difficile infection is the fastest-growing hospital-acquired infection," said Michael Aniskiewicz, infection preventionist, Quality Improvement Support Services. "But with a comprehensive, evidence-based prevention program and the efforts of all clinical and non-clinical staff, we can significantly reduce infection rates."

A team of physicians, YNHH leaders and staff from Infection Prevention, nursing, Pharmacy, Laboratory Medicine and other areas developed the C. diff prevention program that launched in December on all inpatient units. The program includes a "bundle" of practices, such as:

  • An updated isolation policy requiring that patients with C. diff infection be kept on CONTACT PLUS isolation precautions until discharge
  • A new CONTACT PLUS isolation precautions order in Epic for physicians, and an Epic best practice advisory to remind nursing and other staff about these precautions for C. diff patients
  • Disposable blood pressure cuffs and stethoscopes for use in CONTACT PLUS isolation rooms
  • Bleach wipes and specific procedures for cleaning C. diff patient rooms and equipment
  • Red bouffants covering Purell dispensers in CONTACT PLUS rooms to remind staff to wash their hands with soap and water rather than using Purell, which is not effective against C. diff and its spores
  • Education for clinical and non-clinical staff through HealthStream, Infection Prevention rounding and other measures

A key component of the C. diff prevention program is "antibiotic stewardship," in which physicians, in partnership with pharmacists, evaluate the types of antibiotics used to treat patients and recommend alternatives when a safer, more-effective or less-costly option is available. Patients taking certain types of antibiotics are at higher risk for C. diff infection because antibiotics kill off the "good" bacteria that help protect against infections such as C. diff. Other successful program components include standardized lab testing for C. diff at both campuses and education of non-clinical staff, including patient transporters.

"Our primary reason for implementing these best practices is to protect the safety of all of our patients," said Richard Martinello, MD, medical director, Hospital Epidemiology. "C. difficile infections often lead to longer and more costly hospital stays, are a great burden for patients and can even be deadly. Preventing C. diff infection at is a top priority at Yale New Haven Hospital."