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First patient-centred, multidisciplinary clinical audit in hospital/community, study of risk factors, clinical outcomes and patient perspectives of Clostridium difficile-associated diarrhoea

Abstract number: P1471

Guleri A., Sharma R., Palmer R., Huda T., Ambalkar S., Luxton P.

Objectives: Blackpool Victoria Hospital is a large DGH in NW England with two regional speciality centres. Reduction in HCAI is of top priority and has personal engagement of its chief executive. To inform designing of a comprehensive strategy for reducing rate of CDAD, the first patient centred, multidisciplinary clinical audit, enhanced to study associated risk factors, clinical outcomes (cause analysis of deaths) and patients perspective of their disease was undertaken this year across the trust/community. Contributors included patients, hospital doctors, GP and link nurses.

Method: Symptomatic Clostridium difficile toxin positive patients between February – April 2007 were included. When possible, Patients completed part B of the questionnaire.

Results: 63 completed questionnaires were obtained from 147 CDT+ve patients in hospital and community. 85.7% were over 65-years of age and 68.2% females. Majority of patients were from medical units including care of elderly and were admitted to hospital from their own home. 98% specimens were received in lab and 90.1% tested within 24-hrs. Oral Metronidazole used 1st line and up to 78% responded within 5–7 days. Variable non-compliance to initiation of infection prevention protocols noted. Consistent correlation of previous ceftriaxone, ciprofloxacin, co-amoxiclav, levofloxacin, imipenem, clarithromycin and PPI was observed. No association with previous clindamycin use observed. 6 surgical patients had received simultaneous ciprofloxacin /cefuroxime and metronidazole. Most patients became symptomatic within 1–2 weeks of antibiotic use. 2 patients with fulminant colitis had colectomy and 6 patients deaths unrelated/related/caused to CDAD. Patient perspectives included disease associated distress to compliments on excellent management. Variable non-compliance to infection control practices observed by patients.

Conclusion: Variable non-compliance to hospital CDAD management policy and antibiotic formulary; infection control practices; treatment of CDAD; CDT testing; duration and use of antibiotics; informing patients/relatives, and others. Action plan included engagement of directors, consultants, managers, senior nurse leads; change to `narrow spectrum' antibiotic policy; revised CDAD management policy, and others.

A systematic feedback with a named responsible person for proposed actions and discussed at different directorates. A repeat audit is planned at the same time next year. For detailed presentation.

Session Details

Date: 19/04/2008
Time: 00:00-00:00
Session name: 18th European Congress of Clinical Microbiology and Infectious Diseases
Subject:
Location: Barcelona, Spain
Presentation type:
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