Journal Article

Control of an Outbreak of Infection with the Hypervirulent <i>Clostridium difficile</i> BI Strain in a University Hospital Using a Comprehensive "Bundle" Approach

Carlene A. Muto, Mary Kathleen Blank, Jane W. Marsh, Emanuel N. Vergis, Mary M. O'Leary, Kathleen A. Shutt, Anthony W. Pasculle, Marian Pokrywka, Juliet G. Garcia, Kathy Posey, Terri L. Roberts, Brian A. Potoski, Gary E. Blank, Richard L. Simmons, Peter Veldkamp, Lee H. Harrison and David L. Paterson

in Clinical Infectious Diseases

Published on behalf of Infectious Diseases Society of America

Volume 45, issue 10, pages 1266-1273
Published in print November 2007 | ISSN: 1058-4838
Published online November 2007 | e-ISSN: 1537-6591 | DOI:
Control of an Outbreak of Infection with the Hypervirulent Clostridium difficile BI Strain in a University Hospital Using a Comprehensive "Bundle" Approach

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  • Infectious Diseases
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Background. In June 2000, the hospital-acquired Clostridium difficile (CD) infection rate in our hospital (University of Pittsburgh Medical Center–Presbyterian, Pittsburgh, PA) increased to 10.4 infections per 1000 hospital discharges (HDs); the annual rate increased from 2.7 infections per 1000 HDs to 7.2 infections per 1000 HDs and was accompanied by an increase in the frequency of severe outcomes. Forty-seven (51%) of 92 HA CD isolates in 2001 were identified as the “epidemic BI strain.” A comprehensive CD infection control “bundle” was implemented to control the outbreak of CD infection.

Methods. The CD infection control bundle consisted of education, increased and early case finding, expanded infection-control measures, development of a CD infection management team, and antimicrobial management. Process measures, antimicrobial usage, and hospital-acquired CD infection rates were analyzed, and CD isolates were typed.

Results. The rates of compliance with hand hygiene and isolation were 75% and 68%, respectively. The CD management team evaluated a mean of 31 patients per month (11% were evaluated for moderate or severe disease). Use of antimicrobial therapy associated with increased CD infection risk decreased by 41% during the period 2003–2005 (P < .001). The aggregate rate of CD infection during the period 2001–2006 decreased to 4.8 infections per 1000 HDs (odds ratio, 2.2; 95% confidence interval, 1.4–3.1; P < .001) and by 2006, was 3.0 infections per 1000 HDs, a rate reduction of 71% (odds ratio, 3.5; 95% confidence interval, 2.3–5.4; P < .001). During the period 2000–2001, the proportion of severe CD cases peaked at 9.4% (37 of 393 CD infections were severe); the rate decreased to 3.1% in 2002 and further decreased to 1.0% in 2006—a 78% overall reduction (odds ratio, 20.3; 95% confidence interval, 2.8–148.2; P < .001). In 2005, 13% of CD isolates were type BI (20% were hospital acquired), which represented a significant reduction from 2001 (P < .001).

Conclusions. The outbreak of CD infection with the BI strain in our hospital was controlled after implementing a CD infection control "bundle." Early identification, coupled with appropriate control measures, reduces the rate of CD infection and the frequency of adverse events.

Journal Article.  4500 words.  Illustrated.

Subjects: Infectious Diseases ; Immunology ; Public Health and Epidemiology ; Microbiology

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