Bishop Jennifer, Parry Michael F, Hall Timothy
Department of Surgery, Stamford Hospital - Affiliate of Columbia University, 30 Shelburne Road, Stamford, CT 06904, USA.
Conn Med. 2013 Feb;77(2):69-75.
Clostridium difficile (CD) infection is a significant health problem. A new systems approach was introduced to reduce the risk of hospital-acquired CD infection (HA-CD) at our institution. We hypothesized that a practice bundle, including a protocol to limit patient exposures during house staff rounding, would decrease HA-CD infections.
Over a three-year period, 39,093 cases (17,145 inpatients) admitted to the surgical services were reviewed. Cases were reviewed for patient demographics, antibiotic exposures, compliance with antibiotic prophylaxis guidelines, and surgical infections. A resident rounding protocol was developed to limit patient exposures. The program bundle also included a hand washing initiative, maintaining gastric acidity, and antibiotic stewardship.
After implementation of the bundle, the average monthly HA-CD infection rate in surgical patients decreased from 4.13 + 2.6 cases to 1.93 + 1.6 cases, p = 0.03. The overall rate of HA-CD infections for surgical cases decreased 41% from 2.8 cases/1,000 patient days to 1.8 cases/1,000 patient-days.
Bundled programs designed to reduce patient risk by controlling exposure to both environmental and carrier sources of CD can reduce hospital-acquired CD infections.
艰难梭菌（CD）感染是一个严重的健康问题。我们机构引入了一种新的系统方法来降低医院获得性CD感染（HA-CD）的风险。我们假设一个实践组合，包括在住院医师查房期间限制患者接触的方案，将减少HA-CD感染。
在三年期间，对手术科室收治的39,093例病例（17,145例住院患者）进行了回顾。对病例进行了患者人口统计学、抗生素暴露、抗生素预防指南的依从性以及手术感染方面的审查。制定了住院医师查房方案以限制患者接触。该方案组合还包括洗手倡议、维持胃酸度以及抗生素管理。
实施该组合后，手术患者中HA-CD的平均月感染率从4.13±2.6例降至1.93±1.6例，p = 0.03。手术病例中HA-CD感染的总体发生率从2.8例/1000患者日降至1.8例/1000患者日，下降了41%。
旨在通过控制对CD的环境和携带者来源的接触来降低患者风险的组合方案可减少医院获得性CD感染。
