Issue link: https://beckershealthcare.uberflip.com/i/726918
18 Executive Briefing Use of a sporicidal disinfectant throughout a facility (and not just in CDI patient rooms) can help eliminate environmental reservoirs of C. diff and reduce CDI. One hospital recently reported a 70 percent decrease in the incidence of CDI rates and a 63 percent decrease in yearly mortality in patients with CDI infections after implementing a hospitalwide infection control bundle that in- cluded enhanced cleaning of all patient rooms and equipment using a sporicidal bleach-based disinfectant. 10 However, this appears to be the exception as only 10 percent of healthcare facilities surveyed in 2013 used sporicidal disinfectants such as bleach for all patient rooms. 9 Furthermore, noncompliance with CDI disinfection protocols — not following manufacturer's instruc- tions, skipping cleaning steps, not following the order of cleaning outlined in protocols and using less disinfectant or fewer wipes to reduce costs — is a common problem. A recent study showed only 22 percent full compliance with contact isolation precautions in CDI patient rooms, increasing the risk of environmental trans- mission of C. diff spores. 11 The good news is, cleaning and disinfection compliance rates in hospitals can be increased to over 80 percent when process improvements are made. 12 Enhanced disinfection strategies, such as incorporating the use of ultraviolet decontamination systems in addition to surface disinfectants, can also help, especially in areas housing high-risk patient populations. One university hospital that deployed the Clorox Healthcare® Optimum-UV® System in addition to manu- al surface disinfection with bleach-based disinfectants in hema- tology/oncology units demonstrated a 25 percent decrease in CDI rates on the study units and saved an estimated $134,568 to $191,604 in direct medical costs during the 12-month study period. 13 Planning for the Future Proactive and collaborative efforts from healthcare providers, gov- ernment agencies and industry are necessary to prevent CDI. In addition to antimicrobial stewardship efforts to reduce CDI, envi- ronmental cleaning and disinfection is also a key component of multi-modal approaches to reduce transmission of C. diff spores. To ensure robust environment-focused CDI prevention efforts, Clorox Healthcare recommends: 1. Reviewing sporicidal disinfectant efficacy claims and user in- structions to ensure they meet the needs of the facility. 2. Leveraging infection control best practices and guidelines to develop protocols for cleaning and disinfecting surfaces and medical equipment in areas housing CDI patients. 7 3. Expanding the use of sporicidal disinfectants to areas outside of CDI patient care areas to limit the spread of C. diff spores and protect the entire patient population. 4. Investigating the use of enhanced disinfection methods such as UV decontamination systems to supplement manual cleaning and disinfection protocols. n Building on a century-long legacy in cleaning and disinfecting, Clorox Healthcare offers a wide range of solutions to help stop the spread of infection in healthcare facilities. From comprehensive surface disinfection, including advanced ultraviolet technology, to skin antisepsis, we are committed to providing efficacious solutions, designed for compliance, to safeguard patient environments. For more information, visit www.CloroxHealthcare.com or follow @CloroxHealth on Twitter. One hospital recently reported a 70 percent decrease in the incidence of CDI rates and a 63 percent decrease in yearly mortality in patients with CDI infections after implementing a hospitalwide infection control bundle that included enhanced cleaning of all patient rooms and equipment using a sporicidal bleach- based disinfectant. 10 References (1) Saint, S.; et al. Clostridium difficile Infection in the United States: A National Study Assessing Preventive Practices Used and Perceptions of Practice Evidence. Infect. Con- trol Hosp. Epidemiol. 2015, 36 (8), 969–971. (2) Magee, G.; et al. Impact of Clostridium difficile-associated diarrhea on acute care length of stay, hospital costs, and readmission: A multicenter retrospective study of inpatients, 2009-2011. Am. J. Infect. Control 2015, 43 (11), 1148–1153. (3) Centers for Medicare & Medicaid Serivces. Hospital Value-Based Purchasing. https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/hos- pital-value-based-purchasing/ (Accessed Jul 12, 2016). (4) Lessa, F. C.; et al. Burden of Clostridium difficile Infection in the United States. N. Engl. J. Med. 2015, 372 (9), 825–834. (5) Tabak, Y.; et al. Trend of Clostridium difficile Infections by Onset Settings: A Multi- center Study. In ASM Microbe 2016; Poster 290. (6) Kramer, A.; Schwebke, I.; Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect. Dis. 2006, 6, 130. (7) Dubberke, E. R. et al. Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals: 2014 Update. Infect. Control Hosp. Epidemiol. 2014, 35 (6), 628–645. (8) US EPA, Guidance for the Efficacy Evaluation of Products with Sporicidal Claims Against Clostridium difficile (June 2014). https://www.epa.gov/pesticide-registration/ guidance-efficacy-evaluation-products-sporicidal-claims-against-clostridium (Accessed Jul 12, 2016). (9) Association for Professionals in Infection Control and Epidemiology (APIC). CDI Pace of Progress survey | Clostridium difficile Educational and Consensus Conference. http://cdiff2013.site.apic.org/about-the-conference/cdi-pace-of-progress-survey/. (Accessed Aug 4, 2014). (10) Mermel, L. A.; et al. Reducing Clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinary approach. Jt. Comm. J. Qual. Patient Saf. 2013, 39 (7), 298–305. (11) Yanke, E.; et al. Understanding the current state of infection prevention to prevent Clostridium difficile infection: a human factors and systems engineering approach. Am. J. Infect. Control 2015, 43 (3), 241–247. (12) Rupp, M. E.; et al. Maintain the gain: program to sustain performance improvement in environmental cleaning. Infect. Control Hosp. Epidemiol. 2014, 35 (7), 866–868. (13) Pegues, D.; Gilmar, C.; Denno, M.; Gaynes, S. Reducing Clostridium difficile Infec- tion among Hematology-Oncology Patients Using Ultraviolet Germicidal Irradiation for Terminal Room Disinfection; In IDWeek (poster presentation), 2015.