Kick the Bucket: One Hospital System's Journey to Reduce Clostridium Difficile

Albert Einstein defines insanity as doing the same thing over again but expecting different results. Although the United States claims to reduce antibiotic abuse, practice strict isolation, and clean meticulously, the burden of Clostridium difficile outpaces goals. Unless innovative approaches are tried, we risk culling elderly, immunosuppressed, and otherwise debilitated populations. Emergency departments are a primary access point for patients who are unable to wait for primary care. As a result, many patients with diarrhea are seen in emergency departments.

This article describes one hospital system's quality improvement trial of disposable commode pails (DCPs) for high-acuity patients in 3 of 5 institutions. The rationale was to prevent staff from touching surfaces heavily contaminated with C difficile. Staff members were not to wash or reuse commode buckets between patients. Instead, DCPs were substituted, and only the commode chairs were wiped. For quantitative date, C difficile infections (CDIs) were compared across hospitals. Staff members were surveyed for qualitative data.

According to Survey Monkey, the rate of employee satisfaction with the new process was 95%. Fewer sewage backups resulted because nonbiodegradable wipes were disposed inside DCPs rather than in toilets or hoppers. Implementation and product costs were justified through labor savings and a reduced incidence of CDIs. CDI improvements were noted in system hospital emergency departments that used DCPs. Moreover, in one hospital that used DCPs in all nursing units for 1 year, CDI rates were reduced by 32%.

Third-party hospital laboratories generated all CDI data, which reduced bias. However, laboratories were unable to stratify CDIs as inpatient and outpatient in origin. More research is recommended with larger ED patient sample sizes.