The effect of an enhanced infection-control policy on the incidence of Clostridium difficile infection and methicillin-resistant Staphyloccocus aureus colonization in acute elderly medical patients.
BACKGROUND
Clostridium difficile (CD) infection and methicillin-resistant Staphylococcus aureus (MRSA) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. Management is by side-room isolation. Ward closure may be required to control outbreaks.


METHODS
following prolonged bed closures due to CD and MRSA in an acute age-related geriatric service, an enhanced infection control policy was introduced-emphasis on handwashing, cephalosporin restriction, 7-day time limits on antibiotics and feedback of infection rates. The effect of this policy was evaluated by investigating 2,467 consecutive admissions in the 9 months before and after its introduction.


RESULTS
CD infection fell from 36/1,075 admissions (3.35 per 100) to 27/1,392 (1.94 per 100; P < 0.05). MRSA incidence fell from 3.95 per 100 to 1.94 (P < 0.01) whilst that in the rest of the hospital continued to fluctuate. Cephalosporin use fell (and aminopenicillin and trimethoprim use rose) by a factor of three. Unoccupied bed days fell from 1,164 (12.6%) to 513 (5.1%) over the winter, an increase in bed availability of 4.95 a day.


CONCLUSIONS
introduction of the policy was associated with significant reductions in CD infection and unoccupied bed-days and helped maintain a lower incidence of MRSA. It is not clear which elements of the policy most influenced outcome. A multi-centre study is needed to determine whether our findings are generally applicable.
Stone
S P
SP
University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, Royal Free Hospital, Pond Street, London NW3 2QG, UK.
Beric
V
V
Quick
A
A
Balestrini
A A
AA
Kibbler
C C
CC
D000368:Aged; D002511:Cephalosporins / Q000008:administration & dosage / Q000009:adverse effects; D016360:Clostridioides difficile / Q000187:drug effects; D003140:Communicable Disease Control / Q000379:methods*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D004363:Drug Utilization; D004739:England; D020345:Enterocolitis, Necrotizing / Q000453:epidemiology / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D016106:Methicillin Resistance; D010397:Penicillanic Acid / Q000008:administration & dosage / Q000009:adverse effects / Q000031:analogs & derivatives*; D013203:Staphylococcal Infections / Q000453:epidemiology / Q000517:prevention & control*; D013211:Staphylococcus aureus / Q000187:drug effects; D014295:Trimethoprim / Q000008:administration & dosage / Q000009:adverse effects
D002511:Cephalosporins; D010397:Penicillanic Acid; D014295:Trimethoprim; C004408:aminopenicillanic acid