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Clostridium difficile Target. Targets have been set for both acute trusts and SHAs To reflect that it is a whole health economy issue Target for acute trusts is 4 cases per 1,000 admissions by 2010/11. To meet this UHMBT needs to reduce the incidence of C. difficile by appx 100 cases/year.
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Clostridium difficile Target • Targets have been set for both acute trusts and SHAs • To reflect that it is a whole health economy issue • Target for acute trusts is 4 cases per 1,000 admissions by 2010/11. • To meet this UHMBT needs to reduce the incidence of C. difficile by appx 100 cases/year. • Meeting this target will require investment • Recent announcements around the “Clean Safe Care” policy document suggest that money has been identified by DH for this
Spread in hospital Symptomatic patient with diarrhoea +++ Antibiotic control Direct patient-patient spread Spread via healthcare staff Spread via environmental contamination Antibiotics (PPIs, opiates, bowel surgery also increase risk) Prompt isolation Hand hygiene and PPE Effective cleaning Colonised patients
Antibiotic control • Encourage discussion to ensure prescriptions are fully completed • Increase Pharmacists on wards. • Dedicated antibiotic pharmacists • Risks of different antibiotics vary depending on local strains, so local advice essential. • Draft guidelines stipulate weekly ward rounds of all C difficile patients by a microbiologist + physician + ICN + antibiotic pharmacist
Prompt isolation • Patients isolated as soon as symptoms appear • Patients with diarrhoea should have priority for single rooms • Increase single room accommodation
Hand hygiene • Appoint hand hygiene coordinator • Temporary post funded by DH money. • Audit, • Use as educational and improvement tool. • Discipline staff who fail to wash hands • Precedent already set in other trusts.
Effective cleaning • Increase number of cleaners • Make wards easier to clean • Consider the introduction of chlorine-based cleaning agents for general cleaning. • Make sure that equipment can be easily cleaned, and that equipment that cannot be cleaned is replaced. E.g. • Commodes • Mattresses