A multifaceted approach to the management of Hospital-Acquired Clostridium Difficile (c. difficile) infection (HACDI) was taken at Toronto East General Hospital (TEGH) to improve quality of care, health outcomes and the patient experience. This balanced approach has led to a steady decline in c. difficile infection rates, which have been reduced every year for the past five years and are now well below both Provincial and GTA averages. The hospital-wide strategy entailed a wide scope of initiatives:
- The use of a sporicidal cleaning agent (bleach) to disinfect for c. difficile spores,
- The development of standards to reduce human error in the application of the disinfectant,
- ongoing auditing of cleaning processes for high-touch surfaces,
- continued focus on antimicrobial stewardship,
- implementation of a robust hand hygiene strategy, and
- implementation of ultraviolet (UV) irradiation for disinfection.
HACDI can cause severe adverse effects, including medical complications, long-term patient isolation, increased risk of falls, and a deterioration in the overall patient experience. As such, the c. difficile management program (CDMP) was closely linked to the hospital’s Strategic Plan, Quality Improvement Plan and is a key priority for many departments.
The implementation of the c. difficile management program led to four key groups of results: process-oriented, clinical, reputational and financial.
The program has resulted in a reduction in the rate of human error in choosing the right type and/or concentration of disinfectant. This, in turn, has increased productivity of staff.
Clinical outcomes are evident by the significant decrease in c. difficile rates along with the associated adverse outcomes. Since implementation of the program, TEGH’s c. difficile rates have declined to become among the lowest in Ontario and the hospital has consistently achieved its target rate of 0.32 per 1000 patient days. Even lower targets have been set for future goal setting.
While overall costs of the bleach-based sporicidal wipes are higher than other cleaning agents with lower effectiveness, the investment pays off in decreased rates of HACDI and their associated costs.
Given that HACDI can negatively influence a patient’s overall care experience, decreasing c. difficile is important to building patient trust, delivering patient-centered care and maintaining an excellent reputation in the broader community.