title: Clostridium difficile colitis: a retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy.
abstract: BACKGROUND
  Clostridium difficile-associated diarrhea is a leading cause of hospital-acquired diarrhea. We sought to determine whether the institution of a hospital-wide alcohol-based hand rub (ABHR) policy was associated with an increase in the incidence and/or severity of health care facility-onset, health care facility-associated C difficile diarrhea (CDAD).
  
  
  METHODS
  We used a retrospective chart review analysis to compare incidence rates of CDAD before and after implementation of the ABHR policy. We also compared rates of sepsis, colectomy, and death in patients with CDAD before and after implementation of the ABHR policy.
  
  
  RESULTS
  The incidence rate of CDAD was 3.98 per 10,000 patient-days after implementation of the ABHR policy, compared with 4.96 per 10,000 patient-days before implementation (P = .0036). The crude mortality rate in patients diagnosed with CDAD was 10.7% after implementation, compared with 13.3% before implementation (P = .275). The rate of sepsis in patients diagnosed with CDAD was 19.6% after implementation, compared with 5.2% before implementation (P < .0001).
  
  
  CONCLUSIONS
  Our data provide no evidence of an increased CDAD rate after implementation of an ABHR policy at our institution. The rate of sepsis in patients diagnosed with CDAD did rise, indicating increased severity of illness in patients with C difficile infection.
authors.affiliation: Department of Internal Medicine, Carolinas Pathology Group, Carolinas Medical Center, Charlotte, NC, USA. nicole.knight@carolinashealthcare.org
authors.forename: Nicole
authors.initials: N
authors.lastname: Knight
authors.forename: Taylor
authors.initials: T
authors.lastname: Strait
authors.forename: Nicholas
authors.initials: N
authors.lastname: Anthony
authors.forename: Roger
authors.initials: R
authors.lastname: Lovell
authors.forename: H James
authors.initials: HJ
authors.lastname: Norton
authors.forename: Robert
authors.initials: R
authors.lastname: Sautter
authors.forename: Martin
authors.initials: M
authors.lastname: Scobey
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000438:Alcohols / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification; D003082:Colectomy / Q000706:statistics & numerical data; D003428:Cross Infection / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D004202:Disinfectants / Q000627:therapeutic use*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology* / Q000382:microbiology / Q000473:pathology / Q000517:prevention & control*; D006235:Hand Disinfection / Q000379:methods*; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D016134:Organizational Policy; D012189:Retrospective Studies; D018805:Sepsis / Q000453:epidemiology; D055815:Young Adult
chemical_list: D000438:Alcohols; D004202:Disinfectants