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healthcare-associated infections (HAI) program

Clostridium difficile  Infection Prevention Strategies​​

ABOUT

Clostridium difficile is a spore-forming, toxin-producing bacteria that causes diarrheal disease, most commonly in patients with recent healthcare exposure and antibiotic use. C. difficile is able to cause disease and spread rapidly because it is naturally resistant to many of the antibiotics used to treat other infections.

C.difficile infection (CDI) is one of the most common healthcare-associated infections (HAI) acquired in hospitals in the United States. California hospitals track and report CDI as described in the HAI in CA Hospitals Public Report. The California Department of Public Health HAI Program identifies where CDI is most problematic in the state and provides CDI prevention assistance to healthcare facilities. Public health and healthcare providers are coordinating efforts to address this issue across the continuum of care.

Healthcare facilities should:

• Monitor adherence to CDI prevention practices of hand hygiene, contact precautions, and environmental cleaning and disinfection. Measuring adherence and providing feedback to staff are critical to a successful infection prevention program. Use the CDPH HAI Program tools for adherence monitoring.

• Target CDI prevention strategies by identifying opportunities for improvement. Use the CDPH HAI Program Facility CDI self-assessment tool periodically to assess your facility CDI prevention practices.

• Implement antimicrobial stewardship strategies to specifically address CDI. Antibiotic exposure is the major risk factor for CDI when a patient is also exposed to the C.difficile bacterium or spores.
(Coming soon!)

• Evaluate and enhance environmental cleaning and disinfection. Reducing bioburden in the environment decreases potential for transmission of harmful organisms including C.difficile. (Coming soon!)

• Communicate CDI status to receiving facilities ahead of time to ensure appropriate care is maintained when transferring a patient/resident with CDI. A template CDPH Interfacility Infection Control Transfer Form is available.  (Coming soon!)

• Report CDI outbreaks to local public health. Outbreaks in licensed healthcare facilities must also be reported to the local CDPH Licensing & Certification District Office. (Coming soon!)

• Participate in regional CDI prevention efforts. Contact the HAI Program at HAIProgram@cdph.ca.gov for more information.

​Public health partners should:

• Be aware of CDI rates in healthcare facilities and communities. All California acute care hospitals are required to report healthcare facility-onset CDI to CDPH via the National Healthcare Safety Network. These data are reported annually and can be sorted by county. Raw data are available via the Open Data Portal.

• Understand and provide guidance about CDI prevention and control measures to healthcare providers. Refer to the CDI Quicksheet for information on CDI prevention and outbreak investigations in healthcare facilities. A sample line list template is available upon request and can be used for information gathering when an outbreak is suspected. (Coming soon!)

• Set expectations for facilities to effectively communicate CDI status when transferring patients/residents to another healthcare facility. A template CDPH Interfacility Infection Control Transfer Form is available. (Coming soon!)

• Participate in regional CDI prevention efforts. Contact the HAI Program at HAIProgram@cdph.ca.gov for more information.

 

Additional CDI Education and Resources

• Environmental Cleaning and Disinfection Information
CDPH HAI Program

• Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update
Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)



​• Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update
Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)

• Preventing Transmission of Clostridium difficile in Healthcare Settings 2013 Fishbone Diagram
Association for Professionals in Infection Control and Epidemiology (APIC)

 For additional information contact the HAI Program at HAIProgram@cdph.ca.gov.

 

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