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© 1998 Oxford University Press

other

The effect of an enhanced infection-control policy on the incidence of Clostridium difficile infection and methicillin-resistant Staphyloccocus aureus colonization in acute elderly medical patients

SHELDON P. STONE, VIRKA BERIC, ANNE QUICK1, ANITA A. BALESTRINI2 and CHRISTOPHER C. KIBBLER1

University Department of Geriatric Medicine, Royal Free Hospital School of Medicine, Royal Free Hospital Pond Street, London NW3 2QG, UK
1Department of Medical Microbiology and Infection Control Team London, UK
2Department of Pharmacy, Royal Free Hospital NHS Trust London, UK

S. P Stone. Fax: (+44) 171 830 2202.

Background: Clostridium difficile (CD) infection and methicillin-resistant Staphylococcus aureus (MRSA) colonization are increasingly common in elderly patients, are associated with cephalosporin or prolonged aminopenicillin courses and can be transmitted by direct contact. Management is by side-room isolation. Ward closure may be required to control outbreaks.

Methods: following prolonged bed closures due to CD and MRSA in an acute age-related geriatric service, an enhanced infection control policy was introduced—emphasis on handwashing, cephalosporin restriction, 7-day time limits on antibiotics and feedback of infection rates. The effect of this policy was evaluated by investigating 2467 consecutive admissions in the 9 months before and after its introduction.

Results: CD infection fell from 36/1075 admissions (3.35 per 100) to 27/1392 (1.94 per 100; P<0.05). MRSA incidence fell from 3.95 per 100 to 1.94 (P< 0.01) whilst that in the rest of the hospital continued to fluctuate. Cephalosporin use fell (and aminopenicillin and trimethoprim use rose) by a factor of three. Unoccupied bed days fell from 1164 (12.6%) to 513 (5.1%) over the winter, an increase in bed availability of 4.95 a day.

Conclusions: introduction of the policy was associated with significant reductions in CD infection and unoccupied bed-days and helped maintain a lower incidence of MRSA. It is not clear which elements of the policy most influenced outcome. A multi-centre study is needed to determine whether our findings are generally applicable.

Keywords: acute medical patients, Clostridium difficile, infection-control policy, methiallin-resistant Staphyloccocus aureus

Received June 11, 1997; accepted in revised form October 31, 1997.


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