Clostridium difficile situation room

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Clostridium difficile situation room
Educational workshops 2005

• prepared by Kieran Hand, Conor Jamieson, Wendy
  Lawson Hayley Wickens on behalf of UKCPA
  Infection Management Group

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This afternoon

• Scenario
• What data do you need to understand the
  situation?
• What next how will you design and measure the
  effect of an intervention?
• Sharing ideas teamworking
• Feedback

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Current situation

• You have just started working in a 500-bed DGH
  and have noticed there seem to be a large number
  of patients suffering from C. difficile-associated
  diarrhoea.
• Some wards seem to be worse affected than others.
• How would you investigate?

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Some pointers

• Obtain list of positive patients
• Obtain data from Infection Control re
• Incidence historical, location
• isolated cases or transmission?
• Ask pharmacists for antibiotic use data,
  preferably by ward

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C. difficile crisis?
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Antibiotic consumption
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Cephalosporin consumption
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Some pointers (2)

• Ask for detailed antibiotic data
• DDDs/ward, clinical team?
• Cephalosporins broad spectrum agents vs. others
• Antibiotic policy evidence based? Possible to
  change?
• Ask for activity data case mix
• Staffing?
• Levels domestic, nursing etc
• New staff e.g. rotational doctors

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What will you do next?

• Planning an intervention
• Control group?
• ethical considerations
• Be aware of confounding factors
• avoid outbreak situations!
• Time series analysis
• 3 points before, 3 after
• What will your intervention be?

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Measuring outcomes

• Check what you think is happening is actually
  happening
• e.g. compliance with hygiene measures via poster,
  changes in drug usage following policy
  implementation
• What outcomes will you measure?

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To restrict or not to..?

• Whether tis nobler in the mind to suffer the
  slings and arrows of outrageous prescribing..
  or take arms against a sea of.. diarrhoea.. and
  by opposing antibiotics end it..

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e.g. restricting clindamycin

• Hospital-wide restriction of clindamycin led to
  sustained reduction of CDAD 11.5 cases/month
  reduced to 3.3 cases/month
• Clindamycin restriction led to control of
  outbreak prevalence of CDAD increasing by 0.17
  cases/month after restriction fell by 3.68
  cases/month

Climo et al. AIM 1998 128989 Pear et al. AIM
1994 120272