Preventing the Spread of Clostridium Difficile through Systems Change - Research Proposal Example

Hand washing (soap washing and water), contact precaution and meticulous environmental cleaning with an EPA-registered disinfectant are productive in preventing the spread of the organism (McFarland et al. 2004). Hand hygiene combined with other measures such as sanitizing hospital units, judicious antibiotic use can improve infection rates.

Clostridium difficile (C. difficile) a gram-positive anaerobic bacillus that is closely related to the one that causes tetanus and butalism is associated with a gastrointestinal infection, diarrhea and pseudomembranous colitis. C. difficile generally afflicts older hospitalized patients treated with antibiotic drugs. It has two forms, an active, form that is virulent and infectious, and an inactive form that is called a spore is not infectious. Spores can change into the active, infectious form inside the host body. Active forms do not survive for a longer period in the environment contrary to the inactive spores which can survive in the environment for a prolonged period.

C. difficile accounts for 20% -30% of cases of antibiotic-associated diarrhea and is the most commonly recognized cause of infectious diarrhea in healthcare facilities (Bartlett 2002). Annually the excess hospital costs due to its infection in the US are estimated to be $3.2 billion for the years 2000–2002 (O’Brien et al. 2007). Between 2002 and 2006 hospital outbreaks were severe (Loo et al. 2005) and recurrent (Pepin et al. 2005). More than 28,000 deaths occur every year in the US (Weis, 2010) with an overall mortality of 10-15%. Its infection has been on rising in the US and elsewhere. The recent emergence and spread of a virulent strain of C. difficile which is commonly known as NAP1/B1/027 produce more potent toxin and recurrent infections were first identified in Quebec, Canada in late 2002 and have since been found in most states in the U.S. Realizing the severity and threat to patients, hospitals and other healthcare facilities the control and prevention of the disease is really challenging, steps have been taken to stop the spread of C. difficile, but more needs to be done.

Clostridium difficile associated disease (CDAD) is a major cause of healthcare-associated infection-causing morbidity and mortality. The spores are found in hospitals, and medical care facilities, located on the floors, furniture, linens, toilet seats, telephones, shared instrumentation and healthcare workers' hands and accessories. According to McFarland et al. (1989), environment samples showed 29% positive for C. difficile from rooms occupied by asymptomatic patients and 49% in rooms having patients with CDAD. Fawley and Wilcox (2001) showed a significant incidence of C. difficile due to environmental factors.

Lately C. difficile has become more toxic and acquired more resistance to drugs besides it is no longer restricted to patients in hospitals or nursing homes as sizable infections are reported from outside of these facilities. The efficacy of antiseptic hand wash or hand-rub preparations against C. difficile has become a great concern as none of the agents (including alcohols, chlorhexidine, PCMX, and triclosan) is effective against virulent strain. Washing hands with soap and water may help to physically remove spores from the surface, however, a rigorous regimen of hand hygiene is required. Hand washing (soap washing and water), contact precaution and meticulous environmental cleaning with an EPA-registered disinfectant are effective in preventing the spread of the organism (McFarland et al. 1989).

In places with high endemic C.difficile infection rates or in an outbreak setting, the use of dilute solutions of 5.25-6.15% sodium hypochlorite for routine disinfection (Category II) is recommended. Glutaraldehyde, OPA and peracetic acid have been shown to be effective in killing spores. The strategic goals that are generally agreed by the experts of prevention and control of all infectious diseases are: to detect, report, and prevent transmission of infectious organisms, and the interventions that include aggressive detection, isolation of patients, appropriate hand hygiene, thorough disinfection of the environment and personal equipment.

Even though, every aspect of the mentioned intervention may seem self-evident, the key to preventing transmission practice of all components along with the judicious prescription of antibiotics to mitigate the spread of infection. Better compliance and audit to redesign the process is showing results in controlling the disease, albeit, significant data are not available globally of radical change. It is prudent to suggest that hand hygiene exceeds current practice in most health care settings with judicious prescription of antibiotics to ward of any endemic. The drugs of choice are the same old ones: metronidazole and vancomycin.