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Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients.

Publication ,  Journal Article
Turner, MC; Behrens, SL; Webster, W; Huslage, K; Smith, BA; Wrenn, R; Woody, R; Mantyh, CR
Published in: J Am Coll Surg
April 2019

BACKGROUND: In 2017, our hospital was identified as a high outlier for postoperative Clostridium difficile infections (CDIs) in the American College of Surgeons NSQIP semi-annual report. The Department of Surgery initiated a CDI task force with representation from Surgery, Infectious Disease, Pharmacy, and Performance Services to analyze available data, identify opportunities for improvement, and implement strategies to reduce CDIs. STUDY DESIGN: Strategies to reduce CDIs were reviewed from the literature and the following multidisciplinary strategies were initiated: antimicrobial stewardship optimization of perioperative order sets to avoid cefoxitin and fluoroquinolone use was completed; penicillin allergy assessment and skin testing were implemented concomitantly; increased use of ultraviolet disinfectant strategies for terminal cleaning of CDI patient rooms; increased hand hygiene and personal protection equipment signage, as well as monitoring in high-risk CDI areas; improved diagnostic stewardship by an electronic best practice advisory to reduce inappropriate CDI testing; education through surgical grand rounds; and routine data feedback via NSQIP and National Healthcare Safety Network CDI reports. RESULTS: The observed rate of CDIs decreased from 1.27% in 2016 to 0.91% in 2017. Cefoxitin and fluoroquinolone use decreased. Clostridium difficile infection testing for patients on laxatives decreased. Terminal cleaning with ultraviolet light increased. Handwashing compliance increased. Data feedback to stakeholders was established. CONCLUSIONS: Our multidisciplinary CDI reduction program has demonstrated significant reductions in CDIs. It is effective, straightforward to implement and monitor, and can be generalized to high-outlier institutions.

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Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

April 2019

Volume

228

Issue

4

Start / End Page

570 / 580

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Complications
  • North Carolina
  • Infection Control
  • Humans
  • Follow-Up Studies
  • Cross Infection
 

Citation

APA
Chicago
ICMJE
MLA
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Turner, M. C., Behrens, S. L., Webster, W., Huslage, K., Smith, B. A., Wrenn, R., … Mantyh, C. R. (2019). Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients. J Am Coll Surg, 228(4), 570–580. https://doi.org/10.1016/j.jamcollsurg.2018.12.045
Turner, Megan C., Shay L. Behrens, Wendy Webster, Kirk Huslage, Becky A. Smith, Rebekah Wrenn, Regina Woody, and Christopher R. Mantyh. “Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients.J Am Coll Surg 228, no. 4 (April 2019): 570–80. https://doi.org/10.1016/j.jamcollsurg.2018.12.045.
Turner MC, Behrens SL, Webster W, Huslage K, Smith BA, Wrenn R, et al. Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients. J Am Coll Surg. 2019 Apr;228(4):570–80.
Turner, Megan C., et al. “Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients.J Am Coll Surg, vol. 228, no. 4, Apr. 2019, pp. 570–80. Pubmed, doi:10.1016/j.jamcollsurg.2018.12.045.
Turner MC, Behrens SL, Webster W, Huslage K, Smith BA, Wrenn R, Woody R, Mantyh CR. Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients. J Am Coll Surg. 2019 Apr;228(4):570–580.
Journal cover image

Published In

J Am Coll Surg

DOI

EISSN

1879-1190

Publication Date

April 2019

Volume

228

Issue

4

Start / End Page

570 / 580

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Surgery
  • Retrospective Studies
  • Quality Improvement
  • Postoperative Complications
  • North Carolina
  • Infection Control
  • Humans
  • Follow-Up Studies
  • Cross Infection