title: Decreasing Clostridium difficile infections in surgery: impact of a practice bundle incorporating a resident rounding protocol.
abstract: BACKGROUND
  Clostridium difficile (CD) infection is a significant health problem. A new systems approach was introduced to reduce the risk of hospital-acquired CD infection (HA-CD) at our institution. We hypothesized that a practice bundle, including a protocol to limit patient exposures during house staff rounding, would decrease HA-CD infections.
  
  
  METHODS
  Over a three-year period, 39,093 cases (17,145 inpatients) admitted to the surgical services were reviewed. Cases were reviewed for patient demographics, antibiotic exposures, compliance with antibiotic prophylaxis guidelines, and surgical infections. A resident rounding protocol was developed to limit patient exposures. The program bundle also included a hand washing initiative, maintaining gastric acidity, and antibiotic stewardship.
  
  
  RESULTS
  After implementation of the bundle, the average monthly HA-CD infection rate in surgical patients decreased from 4.13 + 2.6 cases to 1.93 + 1.6 cases, p = 0.03. The overall rate of HA-CD infections for surgical cases decreased 41% from 2.8 cases/1,000 patient days to 1.8 cases/1,000 patient-days.
  
  
  CONCLUSIONS
  Bundled programs designed to reduce patient risk by controlling exposure to both environmental and carrier sources of CD can reduce hospital-acquired CD infections.
authors.affiliation: Department of Surgery, Stamford Hospital - Affiliate of Columbia University, 30 Shelburne Road, Stamford, CT 06904, USA.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Bishop
authors.forename: Michael F
authors.initials: MF
authors.lastname: Parry
authors.forename: Timothy
authors.initials: T
authors.lastname: Hall
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D006235:Hand Disinfection; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D014481:United States / Q000453:epidemiology
chemical_list: D000900:Anti-Bacterial Agents