Enhancing Patient Safety through the Management of Clostridium difficile at Toronto East General Hospital

Abstract

In 2005 Toronto East General Hospital experienced a steady increase in the number of C. difficile cases diagnosed within the hospital. This was identified as a patient safety issue, and several areas of the hospital came together to address the problem. Pharmacy immediately started a medication review of past cases. Environmental services took the lead on the environmental cleaning, and a process was put into place with Infection Control so that housekeeping knew of every room that contained a patient with C. difficile and enhanced cleaning could be practised. Staff, including nursing, housekeeping and porters, were educated on C. difficile and the methods of transmission. A business case was developed for a disposable bedpan system, and this was approved by the senior team. A new washable product was tried out with success for the overhead patient light pulls and bathroom call bell systems. Infection rates were shared with staff through a variety of venues. As a result of the initiatives, the hospital has seen a decrease of 50% in the rates of C. difficile. A bonus was that our MRSA rates dropped as well.

UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.

“…As early as 1981 [ 14 ] there was published data demonstrating that the environment of patients with CDAD had a higher likelihood of having C. difficile spores compared to those patients who did not have CDAD (9.3% of 910 floor and surface sites for CDAD patients environments compared to 2.6% of 497 similar sites for non-CDAD patients). Environmental contamination with C. difficile spores is not surprising as Louie [ 12 ] reported that even during and following CDAD treatment patients may shed up to 10 4 spores/g feces and Tomiczek [ 22 ] commented on the fecal aerosols created when bedpan sprayers are used for cleaning in patient bathrooms. Furthermore, Kim et al [ 14 ] demonstrated that spores of C. difficile could survive for five months on the floor.…”

“…It is impossible to conclusively determine the effect of any housekeeping cleaner/disinfector if the compliance of staff with the physical aspect of cleaning cannot be verified. Although there is some evidence that bleach [ 16 , 17 ] or Accelerated Hydrogen Peroxide [ 22 ] can help contain nosocomial spread of CDAD these studies did not attempt to correlate the detection of spores in the environment with the reduction in cases of CDAD. Further studies are needed that use UVM (or some other validated means of assessing cleaning compliance) to correlate the presence of spores in the environment with an intervention using a specific cleaner/disinfector that has activity against C. difficile spores.…”

COVID-19: considerations for the safe management and disposal of human excreta

“…The research articles mainly focused on practices associated with the disposal of excreta during investigations into outbreaks or increased incidents of infection. These were often linked to poor practice and included the use of hand sprays and wands to manually rinse and clean bedpans (either in the patient's room or before using a WD) [ 14 , 17 ]. The manual cleaning process can create splashes and aerosols causing risk of contamination to both the environment and the healthcare worker and is unlikely to remove of all the enteric pathogens [ 18 ].…”

“…One study found 35% of bedpans were inadequately cleaned following reprocessing in WDs during a programme to decrease cases of C.difficile in a Canadian hospital [ 13 ]. Failure to remove the faeces during the WD cycle has led to staff resorting to manual cleaning prior to reprocessing in the WD with the associated risks already identified [ 17 ].…”