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Management of an Outbreak of Clostridium difficile–Associated Disease Among Geriatric Patients

Published online by Cambridge University Press:  21 June 2016

S. Cherifi ,
M. Delmee ,
J. Van Broeck ,
I. Beyer ,
B. Byl  and
G. Mascart
S. Cherifi*
Affiliation:
Departments of Internal Medicine, Brugmann University Hospital, Brussels, Belgium
M. Delmee
Affiliation:
Microbiology Unit, Université catholique de Louvain, Brussels, Belgium
J. Van Broeck
Affiliation:
Microbiology Unit, Université catholique de Louvain, Brussels, Belgium
I. Beyer
Affiliation:
Geriatrics, Brugmann University Hospital, Brussels, Belgium
B. Byl
Affiliation:
Infection Control Unit, Erasme University Hospital, Brussels, Belgium
G. Mascart
Affiliation:
Microbiology, Brugmann University Hospital, Brussels, Belgium Infection Control Unit, Brugmann University Hospital, Brussels, Belgium
*
Hôpital Universitaire Brugmann, Place A. Van Gehuchten, 4, 1020 Brussels, Belgium (soraya.cherifi@chu-brugmann.be)
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Abstract

Objective.

To describe a nosocomial outbreak of Clostridium difficile–associated disease (CDAD).

Design.

A traditional outbreak investigation.

Setting.

Geriatric department of a tertiary care teaching hospital from March through April 2003.

Methods.

The outbreak was detected by the C. difficile surveillance program of the infection control unit. CDAD was diagnosed by stool culture and fecal toxin A detection with a qualitative rapid immunoassay. Isolates of C difficile were serotyped and genotyped using pulsed-field gel electrophoresis.

Results.

The incidence of CDAD increased from 27 cases per 100,000 patient-days in the 6-month period before the outbreak to 99 cases per 100,000 patient-days during the outbreak. This outbreak involved 21 of 92 patients in 4 geriatric wards, which were located at 2 geographically distinct sites and staffed by the same medical team. The mean age of patients was 83 years (range, 71-100 years). Five (24%) of the 21 patients had community-acquired diarrhea, and secondary hospital transmission resulted in 3 clusters involving 16 patients. Serotyping and genotyping were performed on isolates in stool specimens from 19 different patients; 16 of these isolates were serotype A1, whereas 3 displayed profiles different from the outbreak strain. Management of this outbreak consisted in reinforcement of contact isolation precautions for patients with diarrhea, cohorting of infected patients in the same ward, and promotion of hand hygiene. Relapses occurred in 6 (29%) of 21 patients.

Conclusion.

Control of this rapidly developing outbreak of CDAD was obtained with early implementation of cohorting and ward closure and reinforcement of environmental disinfection, hand hygiene, and enteric isolation precautions.

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 27 , Issue 11 , November 2006 , pp. 1200 - 1205
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2006

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