Surveillance of Clostridium difficile infections in a long-term care psychogeriatric facility: outbreak analysis and policy improvement.
BACKGROUND
Following an exceptionally high Clostridium difficile infections (CDI) incidence (Spring 2011) in a psychogeriatric long-term care facility, a bidirectional study (2009-2012) was initiated to identify determinants (retrospectively) and to assess intervention measures taken (prospectively).


METHODS
For every CDI patient (de novo cases, relapses, and recurrences), a control patient (patient in the opposite room) was selected and risk factor analysis performed. Following the epidemic peak a more stringent hygienic protocol and surveillance program were implemented, as well as uniform guidelines for metronidazole and vancomycin prescription.


RESULTS
The nutritional state (total protein/prealbumine) significantly differed between the CDI group (poorer nutritional state at admission) and the control group, and also antibiotic use (general) could be confirmed as a risk factor. A multi-disciplinary nutritional team has been established in order to improve the nutritional balance of our patients.


CONCLUSIONS
Aside from stringent hygiene and antibiotic prescription stewardship, malnutrition of patients is a factor to be taken into account to contain a CDI outbreak in a long term care facility (LTCF).
Scheutbos, Revalidation Centre for Psychogeriatric patients, Brussels, Belgium.
Gretel
G
Van Esch
Department of Clinical Microbiology, Cliniques Universitaires Saint-Luc (UCL), Brussels, Belgium.
Johan
J
Van Broeck
Department of Clinical Microbiology, Cliniques Universitaires Saint-Luc (UCL), Brussels, Belgium.
Michel
M
Delmée
Healthcare-associated Infections (NSIH) & Antimicrobial Resistance, OD Public Health & Surveillance, Scientific Institute of Public Health, Brussels (WIV-ISP), Rue Juliette Wytsmanstraat 14, 1050 Brussels, Belgium.
Boudewijn
B
Catry
Clostridium difficile; Intervention; LTCF; Nutritional status