A growing number of healthcare facilities are thinking beyond isolation rooms and implementing standardizing cleaning protocols to fight HAIs facility-wide. Here’s why.
Clostridium difficile (C. difficile), an infectious and potentially life threating bacteria that is resistant to many commonly used disinfectants and can survive on environmental surfaces for months, is one of the most prevalent causes of healthcare-associated infections (HAIs) in the United States.1
Historically, environmental hygiene strategies for preventing the spread of C. difficile have focused on patient isolations rooms, but mounting evidence suggests that it may be time to start thinking more broadly. For example, a recent study published in JAMA Internal Medicine used electronic health records to construct a map of where all patients with C. difficile infections had travelled in the hospital over a three-year period and identified a particular CT scanner in the Emergency Department as a significant source of exposure-related infections.2 Another study published in the New England Journal of Medicine found that genetically diverse sources of C. difficile accounted for 45 percent of cases, suggesting involvement of sources beyond symptomatic patients in the transmission process.3
These results and others speak to a creeping concern shared by many in infection prevention, that only using infection control measures to prevent C. difficile transmission from isolation rooms and for patients known to have C. difficile is a little like shutting the barn door after the horse has bolted.
As a result, a growing number of healthcare facilities are now expanding use of sporicidal disinfectants and pursuing cleaning and disinfecting protocols designed to kill as wide a range of common healthcare-associated pathogens as possible. Below, I’ll take a closer look at two hospitals that have made the change and results they’ve achieved so far.
Fairfield Medical Center
After seeing a spike in C. difficile cases from 2015 to 2016, infection control practitioners at Fairfield Medical Center launched an innovative multi-pronged infection prevention campaign. Beginning in December 2016, they worked in close collaboration with senior leadership, clinical staff and Environmental Services teams to enhance environmental cleaning, optimize hand hygiene, and improve screening for C. difficile. As part of the intervention, Clorox Healthcare® Fuzion™ Cleaner Disinfectant, a next-generation bleach product that kills C. difficile spores in two minutes, was implemented throughout the hospital in all inpatient and outpatient areas, on all furniture and in all public spaces such as waiting rooms, public restrooms and common areas. Fuzion, which has a very low odor profile, leaves little to no residue and is compatible with a wide range of surfaces, is designed to enable expansive daily use.
According to Infection Control Practitioners, Kristin Shuman, MSN, RN, CNL and Tina Cass, MSN, RN, CNL, the facility-wide approach offered significant benefits compared to traditional models wherein regular bleach use is limited to patient isolation rooms and areas with historically high rates of infection.
“Patients with C. difficile don’t always show symptoms and many visit ERs, sit in waiting areas, walk hallways and go for additional tests or lab work before a diagnosis is reached,” said Shuman. “If you’re only using bleach in isolation rooms, you can’t adequately address asymptomatic carriage and may be missing important exposure-related infection risks at other points in the patient journey.”
Between December 2016 and October 2017, the campaign led to an 88 percent reduction in C. difficile infection rates.4 Fairfield Medical Center realized further reductions from 2017-2018, and from January-July 2018, maintained a 0.68 standardized infection ratio (SIR).
St. Vincent Healthcare
In December 2017, St. Vincent Healthcare introduced a standardized, bleach-based cleaning and disinfecting protocol to fight C. difficile, enhance infection prevention and promote patient safety facility-wide. After assessing a wide range of options, the Environmental Services Department and Infection Control Committee decided to consolidate disinfecting products and implement Fuzion for all daily and terminal cleaning in patient care areas and public spaces such as waiting rooms, hallways, elevators and public restrooms. Implementation was supported by formal training on compliant product use and the introduction of standardized cleaning practices designed to optimize cleaning thoroughness and efficacy.
“Some healthcare facilities wait for a positive diagnosis of C. difficile infection to place patients on isolation precautions and start cleaning just their rooms with bleach, but with Fuzion, we are able to be much more proactive,” said Environmental Services Manager, Michael Swavely. “Our standardized, bleach-based protocol ensures we are killing C. difficile spores and other dangerous pathogens everywhere they pose a threat, providing the same high standards of cleanliness and safety in public restrooms and waiting areas as in isolation rooms and ICUs.”
Optimizing Infection Prevention Facility-Wide
Environmental hygiene plays a critical role in infection control and the delivery of safe, high quality patient care, but not all cleaning and disinfecting products and protocols are created equal and today’s healthcare facilities need solutions that can stand up to a wide range of threats. Looking ahead, I anticipate that we will continue to see a trend toward expanded sporicidal disinfection to optimize infection prevention and enhance patient safety facility-wide.
References
- Saint, S, et al. “Clostridium difficile Infection in the United States: A National Study Assessing Preventive Practices Used and Perceptions of Practice Evidence.” Infect. Control Hosp. Epidemiol. 2015;36.8:969–971.
- Croci R, et al. “Using Spatial and Temporal Mapping to Identify Nosocomial Disease Transmission of Clostridium difficile.” JAMA Intern Med. Published online October 23, 2017. doi:10.1001/jamainternmed.2017.5506
- Eyre DW, Cule ML, Wilson DJ, Griffiths D, Vaughan A, O’Connor L, Golubchik T, Batty EM, and Finney JM. “Diverse Sources of C. Difficile Infection Identified on Whole-genome Sequencing.” New England Journal of Medicine 369 (2013): 1195-1205.
- Schuman, K, Cass, T. “Battling hospital acquired Clostridium difficile with innovative infection prevention tools.” American Journal of Infection Control (2018)46.6, S87.
