Epidemiology and Impact of Clostridium. difficile Colonization

Epidemiology and Impact of Clostridium. difficile Colonization
PI: Trish Perl, M.D., M.Sc.
Sponsor: Centers for Disease Control and Prevention (CDC) 

In this project, we will determine the impact of C. difficile as a significant nosocomial pathogen and its associated morbidity, mortality and cost.  This will be accomplished by investigating the increased incidence among patients who are exposed to antimicrobial agents (especially fluoroquinolones), and improperly cleaned environments, and by determining whether the use of proper hand and environmental cleaning agents and technique will decrease incidence of CDAD (C. difficile associated diarrhea) and its attributable clinical and financial burden.

To accomplish this, we propose four studies:

1. To prospectively identify patients at high risk for CDAD;
2. To identify risk factors for colonization and/or development of disease.  Risk factors associated with contaminated environments (the physical room and care givers in contact with the patient), the type, duration and burden of antimicrobial agents (especially fluoroquinolones), and organism characteristics will be studied, (antimicrobial resistance and strain typing using two methods, PFGE and repetitive sequence PCR), along with associated outcomes of CDAD including: excess antimicrobial use, length of hospitalization, and hospital costs in a prospective cohort of patients with CDAD;
3. To determine the excess length of hospital stay, mortality and in-patient costs associated with CDAD disease by comparing patients with CDAD to control patients with similar underlying disease, severity of illness, hospital exposure;
4. To deploy a two-step intervention composed of systematic cleaning with a competency training module.  Infection rates observed before and after intervention will be compared and reported to care givers.
5. To assess the rate of C. difficile contamination in the environment of the patient’s room before and after the education intervention above.  To compare the use of two different cleaning solutions in room decontamination (the currently used cleaner – a quaternary cleaner – and a sodium hypochlorite solution.
6. To assess the rate of hand contamination among health care workers who work with patients with CDAD. 

For more information, please e-mail Courtney Wilburn or Kathleen Speck, or contact them at (410) 614-6206.