Successful control of an outbreak of Clostridium difficile 027

Royal Devon and Exeter NHS Foundation Trust

Case study contributors:

Judy Potter (Lead Nurse, Infection Control, Royal Devon and Exeter NHS Foundation Trust), Penny Criddle (Infection Control Nurse, Royal Devon and Exeter NHS Foundation Trust), Alaric Colville, (Consultant Microbiologist, Royal Devon and Exeter NHS Foundation Trust), Jonathan A. Otter (BIOQUELL (UK) Ltd).

The Royal Devon and Exeter Hospital experienced an outbreak of C. difficile 027. The incidence of C. difficile-associated disease (CDAD) increased dramatically early in 2005 from less than 40 to more than 80 cases per month. Several interventions were implemented immediately according to national guidelines, including increased training and monitoring of hand hygiene, the introduction of chlorine containing cleaning products and training and guidance on reducing the use of antibiotics. Initially, the introduction of moxifloxacin was thought to have caused the outbreak, but the theory was not supported by the antibiotic usage data and the number of cases did not reduce when the antibiotic policy changed. Following the identification of C. difficile 027 as the predominant type amongst the outbreak isolates, isolation was improved by implementation of a cohort ward for affected patients, rather than relying on ward side rooms. This response proved to be dramatically successful, and cases returned to baseline numbers within a month, being maintained there or below for 16 months so far. The initial cohort ward was decontaminated (as a smaller facility was used) with HPV (BIOQUELL (UK) Ltd) as a precaution before being returned to general use. Further typing showed that the 027 strain, although still present, was no longer the predominant strain in the hospital.

Other information or references:

Bates CJ, Pearse R. Use of hydrogen peroxide vapour for environmental control during a Serratia outbreak in a neonatal intensive care unit. J Hosp Infect 2005;61:364-366.

Boyce JM. Environmental contamination makes an important contribution to hospital infection. J Hosp Infect 2007;65 Suppl 2:50-54

French GL, Otter JA, Shannon KP, Adams NM, Watling D, Parks MJ. Tackling contamination of the hospital environment by methicillin-resistant Staphylococcus aureus (MRSA): a comparison between conventional terminal cleaning and hydrogen peroxide vapour decontamination. J Hosp Infect 2004;57:31-37.

Jeanes A, Rao G, Osman M, Merrick P. Eradication of persistent environmental MRSA. J Hosp Infect 2005;61:85-86.