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C. difficile infections: NHS on track to achieve annual reduction of 30% by 2010/11
C. difficile infections are continuing to fall, the latest quarterly statistics from the Health Protection Agency (HPA) showed today.
There were 8,947 C. difficile infections in in England between July and September 2008. This represents a 33% reduction compared to the same quarter last year and a 35.5% reduction compared to the average quarter in 2007/08. The figures show a drop in C. difficile cases across all age groups for July to September 2008.
The NHS is on track to achieve the national target of reducing C. difficile infections by 30% by 2010/11 against the 2007/08 baseline. To meet the target, a reduction of at least 30% compared to the average quarter in 2007/08 would need to be sustained over four consecutive quarters.
Announcing the figures, Health Secretary Alan Johnson said:
"This is very good news, and shows that the relentless focus on tackling infections has been working effectively. It isn't just about extra investment and tighter regulation - it's also about ensuring that everyone follows the hand-washing routine, the bare below the elbows dress code, the proper hygiene measures and responsible prescribing of antibiotics - which is particularly important in relation to C. difficile."
Today, the Department of Health also published new expert guidance on the management of C. difficile in hospitals. This brings together expert advice on control of C. difficile to provide a single comprehensive source of scientific guidance for the NHS.
Key recommendations with specific regard to cleaning and disinfection include:
* Environmental cleaning of rooms or bed spaces of C. difficile patients should be carried out at least daily using chlorine-containing cleaning agents (at least 1,000 ppm available chlorine).
* All commodes, toilets and bathroom areas of CDI patients should be cleaned after each use with chlorine-containing cleaning agents (at least 1,000 ppm available chlorine).
* All clinical areas should be regularly assessed for cleanliness and results fed back to clinical and cleaning teams.
* Infection prevention and control teams, matrons and cleaning staff should meet regularly (at least monthly) to discuss results across the hospital. Particular attention should be paid to toilet and bathroom scores.
* Terminal cleaning of a mattress, bed space, bay or ward area after the discharge, transfer or death of a patient with CDI should be thorough. All areas should be cleaned using chlorine-containing cleaning agents (at least 1,000 ppm available chlorine), and the curtains should be changed. Consideration should be given to the use of vaporised hydrogen peroxide to provide total
* disinfection of the environment/equipment in single rooms/isolation wards. Trusts should have a specific protocol for this and carry out an audit of compliance with it.
* The ward environment should not be cluttered. The recent Releasing Time to Care: The Productive Ward initiative by the NHS Institute promotes this.
* Medical equipment should ideally be for single patient use, but if that is not possible it should be thoroughly cleaned before and after each new patient use. This process should be recorded and audited together with regular checks of the integrity of surfaces including mattress covers.
* Chlorine-containing cleaning agents should be made up to the correct concentration and stored in accordance with manufacturers' instructions, with particular attention being paid to compliance with health and safety regulations.
* Routine environmental screening for C. difficile is not recommended, but ma be useful to ascertain whether cleaning standards are suboptimal, notably in the outbreak or hyperendemic setting.
* Trusts should ensure, through their directors of nursing and human resources, that each clinical area is covered by an infection control link practitioner, whose role and job description should include training, auditing and feeding back to staff on cleaning, isolation, hand hygiene and personal protective clothin practices. This could be either a member of the clinical team or one of a number of designated posts attached to the infection prevention and control team, each covering several clinical teams or a clinical directorate full time.
23Copies of the new C. difficile guidance can be found on the Department of Health website:
15th January 2009