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Is the emergency department the place to be for optimum Clostridium difficile-associated disease control?

Abstract number: P1490

Dhondt E., Cossey V., Schuermans A., Duerinckx R., Knockaert D.

Background: Alerted by the rise and severity of nosocomial Clostridium difficile (CD)-associated disease (CDAD) and the high suspicion of import diarrhoea, a tertiary care teaching hospital set up a hospital-wide infection control (IC) programme, aiming at increasing CDAD-detection, improving standard precautions, organising IC practitioner rounds, environmental disinfection with hypochlorite, early contact isolation and peroral vancomycine antibiotic treatment. To date CD ribotype 027 in Belgium accounts for 23% of all strains tested.

Objective: To identify the importance of the emergency department (ED) as an entry point of CDAD, since its case mix consists of patients at high risk of both introducing and acquiring infections.

Methods: A retrospective study of CDAD was conducted reviewing ED admission and discharge data of 4960 patients presenting with diarrhoea between January 1, 2002 and November 15, 2007. Variables included are epidemiological (age, sex, origin, dismissal) as well as bacteriological (CD-culture and -toxin analysis).

Results: A total of 1926 CD-analyses were performed, showing a mean total detection effort of 40%, yet increasing over the study period: 34% (2002), 32% (2003), 35% (2004), 40% (2005), 41% (2006) and 53% (2007). Of these, 166 (originating from 146 patients) were found CD-toxin positive, indicating a CD-recovery rate of 9%, which is even threefold the overall hospital detection yield.

Of the studied ED patients 27% were aged above 65, representing 68% (99/146) of the CDAD affected. Hospital admission for diarrhoea (3068 out of 4960) accounted for 62%. Only 4.5% were transferred from long-term care facilities. There was no sex difference observed.

Conclusion: Increasing ED awareness and a high CD-recovery rate stress the importance of the ED in expediting case detection.

The high hospitalisation rate of patients presenting with diarrhoea and a clear import pattern moreover urge for early prevention of transmission by timely syndromic application of contact precautions. Above 65 years of age, quarantine may be warranted in all diarrhoeic patients, yet not workable. Isolation based on risk factors (comorbidity, previous antibiotic or antacid exposure or CDAD history) seems more feasible. Therefore, this case mix of ED patients needs more refinement.

In the mean time, clinical condition based IC practices should emphasise on hand hygiene, high touch surface disinfection and careful selection and handling of medical items.

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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