CQI Activities for the Reduction of Clostridium difficile Associated Diarrhea in NCU of a University Hospital

Park, Eun Suk; Chang, Kyung Hee; Youn, Young Ok; Lee, Jung Sin; Kim, Tae Gon; Yea, Han Seung; Kim, Sun Ho; Shin, Jeong Won; Lee, Kyungwon; Kim, June Myung

Journal of Korean Society Quality Assurance Health Care 2001;8(1): 10.
Published online June 30, 2001.

일개 대학병원 신경외과중환자실에서 Clostridium difficile 관련 설사 감소를 위한 CQI활동

박은숙¹, 장경희², 윤영옥³, 이정신³, 김태곤⁴, 여한승⁴, 김선호⁴, 신정원⁵, 이경원⁵, 김준명¹

¹세브란스병원 감염관리실
²연세대학교 의과대학 감염내과
³세브란스병원 간호부
⁴연세대학교 의과대학 신경외과
⁵연세대학교 의과대학 임상병리과

CQI Activities for the Reduction of Clostridium difficile Associated Diarrhea in NCU of a University Hospital

Eun Suk Park¹, Kyung Hee Chang², Young Ok Youn³, Jung Sin Lee³, Tae Gon Kim⁴, Han Seung Yea⁴, Sun Ho Kim⁴, Jeong Won Shin⁵, Kyungwon Lee⁵, June Myung Kim¹

¹Infection control office, Severance Hospital
²Division of Infectious Disease, Department of Internal Medicine, Yonsei University, College of Medicine
³Department of Nursing, Severance Hospital
⁴Department of Neurosurgery, Yonsei University College of Medicine
⁵Department of Clinical Pathology, Yonsei University College of Medicine

Abstract

Background
The Clostridium difficile is the most important identifiable cause of nosocomial infectious diarrhea and colitis, which lengthens hospital stay. Recently incidence of C. difficile has been increasing in an university hospital, and an intervention for prevention and control of C. difficile associated diarrhea (CDAD) was in prompt need.
Methods
Subjects were the patients in the neurosurgical intensive care unit(NCU) where C. difficile was most frequently isolated. To increase participation of various departments, we used the CQI method, because management of CDAD requires a wholistic approach including control of antibiotics, barrier precaution and environmental cleaning and disinfection. Duration of the CQI activities was 9 months from April to December 1999.
Results
The identified problems were misuse and overuse of antibiotics, lack of consciousness of medical personnels and the possibility of transmission from the contaminated environment and tube feeding. Education for proper use of antibiotics and management of C. difficile infection, use of precaution stickers, supplement of handwashing equipments, emphasis on environmental disinfection, and the change of the process of tube feeding were done. The CDAD rate in NCU was significantly decreased after the CQI program (8.6 case per 1,000 patient days from January to April 1999 vs 4.8 from May to December 1999). The distribution of neurosurgical wards including NCU among the total number of isolated C. difficile from the clinical specimens dropped from 49.4% in January to April to 33,7% in May to December. The average hospital stay of the neurosurgical department changed from 19.6 days to 15.2 days. Also, the effect of the CQI activities for C. difficile may have affected the incidence of vancomycin resistant enterococci (VRE). Duration and dosage of certain antibiotics used in the NS department were decreased. The distribution of neurosurgical department in the number of VRE isolated patients declined from 18.4% to 11.1%.
Conclusion
Infection control of resistant organisms such as C. difficile is likely to be successful when management of environmental contamination an collaborative efforts of decreasing the patients' risk factors such as antibiotics management and decreasing the length of hospital stay come simultaneously. For this work, related departments need to actively participate in the entire process under a common target through discussions for identifying problems and bringing up solutions. In this respect, making use of a CQI team is an efficient method of infection control for gathering participation and cooperation of related departments.

Key words C. difficile associated diarrhea;CQI activities;NCU;Infection control;