title: Designing a protocol that eliminates Clostridium difficile: a collaborative venture.
abstract: BACKGROUND
  Clostridium difficile is a health care-associated pathogen that is difficult to eradicate in the health care environment through the use of common hospital disinfectants. Many of these disinfectants fail to inactivate C difficile spores, which can result in patient-to-patient transmission. This study demonstrates that the use of 10% hypochlorite solution, along with interventions, reduced the incidence of health care-associated C. difficile infection.
  
  
  METHODS
  A case-only study was conducted over a 24-month period. Interventions used to reduce the incidence of health care-associated C difficile included 10% hypochlorite disinfection, soap and water hand hygiene, contact isolation for suspected and confirmed cases, educational tool for patients and visitors, daily isolation rounds, automated report functions, and standardized nursing unit isolation processes. The microbiology method that was used to isolate the C difficile organism for DNA typing included a minimum of 1 mL of stool placed in a conical screw top tube, and then an equal volume of 95% ethyl alcohol was added to the tube. Prereduced blood agar plates were inoculated with the treated and untreated specimen. Plates were incubated anaerobically for 48 hours at 37 degrees C. Plates were examined for gray, flat colonies and gram stains performed; further testing was performed only on gram-positive rods.
  
  
  RESULTS
  A 66% reduction in the number of health care-associated C difficile cases was achieved during the study. A total of 25 isolates was DNA typed per pulse-field gel electrophoresis. Two distinct genetic patterns were identified. Results yielded that the Florida isolates also had the epidemic strain of the organisms that was noted in Quebec, Canada and other parts of the United States.
  
  
  CONCLUSIONS
  A combination of automated daily isolation reports, use of a standardized methodology for isolation rounds, as well as development of a 10% hypochlorite disinfection protocol resulted in a dramatic decrease in health care-associated C difficile cases. Weekly nursing director reports and daily rounds by nursing leadership keep the direct line supervisors abreast of infection control issues on their respective nursing units. The addition of the dual-chamber bleach container ensured that the proper dilution was achieved when disinfecting reusable equipment.
authors.affiliation: Infection Control Department, University Community Hospital, Tampa, Florida 33613, USA. jwhitaker@mail.uch.org
authors.forename: Jacqueline
authors.initials: J
authors.lastname: Whitaker
authors.forename: B Susan
authors.initials: BS
authors.lastname: Brown
authors.forename: Sue
authors.initials: S
authors.lastname: Vidal
authors.forename: Maria
authors.initials: M
authors.lastname: Calcaterra
mesh_terms: D016360:Clostridioides difficile / Q000187:drug effects / Q000235:genetics / Q000472:pathogenicity*; D003015:Clostridium Infections / Q000209:etiology / Q000517:prevention & control*; D015331:Cohort Studies; D003428:Cross Infection / Q000517:prevention & control*; D003625:Data Collection / Q000379:methods; D004202:Disinfectants / Q000627:therapeutic use; D004403:Dysentery / Q000209:etiology / Q000517:prevention & control*; D005431:Florida; D006801:Humans; D017053:Infection Control / Q000379:methods* / Q000458:organization & administration; D009732:Nursing Care / Q000458:organization & administration*; D010356:Patient Isolation; D012973:Sodium Hypochlorite / Q000627:therapeutic use; D016635:Universal Precautions
chemical_list: D004202:Disinfectants; D012973:Sodium Hypochlorite