Eradicating Clostridium Difficile in Hospital Settings Madeline Dyson, Brooke Hyler, Emma Jagasia, Mikayla Large, Karoline Tamoney

Proposed Practice Change Implement a standardized disinfection guideline for Clostridium Difficile. Ultra violet environmental disinfection (UVD), disinfection of gloves before removal, and hand hygiene using soap rather than disinfection gels. As a result, it is evident that acute hospital systems as well as patients would greatly benefit from having strict and specific Clostridium difficile protocols during every hospital stay. After reviewing the rates of Clostridium difficile incidences in acute hospital settings and discussing the protocols for disinfection in the Bay Area, it was evident a standardized disinfection guideline should be put into place. The proposed guideline would include use of Ultra violet environmental disinfection (UVD), disinfection of gloves before removal, and hand hygiene using soap rather than disinfection gels. Read 3rd bullet from powerpoint

FACTS: In the United States, 165,000 cases are reported each year. Clostridium difficile causes 9,000 deaths annually. The hospital costs for treating Clostridium difficile is an excess of $4.8 billion dollars yearly. Over 80% of deaths were in patients over 65 years of age. In 2015, 1 out of 9 patients who were 65 years or older, died within 30 days of Clostridium difficile diagnosis (CDC, 2015).

PLAN: Supportive Literature Implementing a standardized Clostridium difficile protocol has the potential to decrease nosocomial infection rates, deaths, and hospital excess costs. Studies show the use of UVD has a 20% decrease in the number of hospital acquired infections (Haas, Dusza, Dusza, Montecalvo, 2014). Incidence of hospital-acquired multiple drug resistant organisms plus Clostridium difficile from January 2009 until April 2013.

PLAN: Supportive Literature Implementation of proper PPE removal and disinfection of gloves with bleach wipes significantly decreases the incidence of Clostridium difficile spores on healthcare providers hands, thus decreasing the prevalence of contamination to patients (Thomas, Venkata, Kundrapu, Wilson, & Donskey, 2015). According to a study performed by a group of medical personnel at Cleveland Veteran Affairs Medical Center, the This chart Shows the Acquisition of C difficile on the hands of health care personnel caring for patients with CDI before and after a sequential intervention of this study. The first phase of the intervention included education on PPE removal and guided practice using fluorescent lotion to reduce contamination during removal of gloves and gowns. In the second phase of the intervention, disinfection of contaminated gloves with bleach wipes before removal was added. 16% of nurses hands were contaminated with C.diff spores after performing care during the preintervention trial. 4% were contaminated after phase one 0% were contaminated after phase two!!!!!

Plan: Supportive Literature When disinfecting, using only alcohol based gels, 62% of Clostridium difficile spores remain on the hands of those in contact. This report concluded soap and water drastically reduces the incidence of transmission (Oughton, Loo, Dendukuri, Fenn, & Libman, 2007). While we all already know that this has been proven to work we still want this intervention to be included in our protocol A report conducted by faculty of the Medical College of Wisconsin, declared when 62% spores left on hands after hand jell 1-5% spores left on hands after WWS

DO: Evaluate and Educate Evaluation: Determine the incidence of hospital acquired Clostridium difficile infection rate Assess the current protocols associated with transmission Create an education tool to determine staff understanding of transmission. Education: Infection Control will teach proper disinfection techniques both during and after hospitalization of a patient with C diff. References with evidence based research will be discussed and distributed to all staff involved in patient care. At the prospective hospital for the proposed change we need to evaluate….. Look to slide EDUCATION this includes nursing, medical, and environmental staff

DO: Evaluate and Educate Engagement: Staff involvement will be promoted through a monthly hospital evaluation, reporting the incidence of unit based Clostridium difficile infections. Incentives will be provided monthly to the unit with the least incidence of new onset infections. Pilot program: Standardized Clostridium difficile protocol for all units hospital wide.

Use UV to disinfect room Clean gloves and equipment Wash Hands Use UV to disinfect room Clean gloves and equipment

DO: Implementing a New Protocol Teach patient care staff the recommended techniques to prevent transmission of Clostridium difficile. Nurses should be instructed to educate patients and visitors about the protocol Recommendations: Disinfection gloves before removal of PPE Wash hands with warm water and soap After discharge, incorporate the use of Ultraviolet environmental disinfection Teach patients and visitors on proper use of PPE and hand hygiene the importance of personal protective equipment (PPE) and proper hygiene.

STUDY During a three month time frame following the implementation of standardized Clostridium difficile protocol Determine the number of new hospital acquired CDI cases Assess effectiveness of nursing education tools Evaluate patient and visitor knowledge Reevaluate measures and protocols if no change or a negative change in prevalence of hospital acquired clostridium difficile is present Do the patients and visitors know of infections protocols by observing implementation of protection measures

ACT: Generalizability Implement hospital wide protocol Ultra violet disinfection devices distributed to environmental staff In service education to staff members Educational resources to aid in patient teaching Depending on success of pilot study, standardized c diff protocol will be implemented hospital wide. Environmental staff will be educated on how to properly work UVD machines for disinfection of pt rooms All health team members will receive an in-service to review standardized c diff protocol and education about the transmission of infection Nursing Staff will be provided with

References Centers for Disease Control and Prevention. (2015). Nearly half a million Americans suffered from Clostridium difficile infections in a single year. Retrieved from http://www.cdc.gov/media/releases/2015/p0225-clostridium-difficile.html Haas, J., Menz, J., Dusza, S., Montecalvo, M. (2014). Implementation and impact of ultraviolet environmental disinfection in an acute care setting. American Journal of Infection Control, 42(6), 586–590. doi: 10.1016/j.ajic.2013.12.013 Oughton, M., Loo, V., Dendukuri, N., Fenn, S., Libman, M. (2007). Hand hygiene with soap and water Is superior to alcohol rub and antiseptic wipes for removal of clostridium difficile. Infection Control and Hospital Epidemiology, 30(10), 939-944. doi: 10.1086/605322 Thomas, M., Venkata, S., Kundrapu, S., Wilson B., Donskey, C. (2015). An intervention to reduce health care personnel hand contamination during care of patients with clostridium difficile infection. American Journal of Infection Control, 43(12), 1366–1367. doi: 10.1016/j.ajic.2015.07.017