Safe prevention of Clostridium difficile using infectious disease guidelines at an urban hospital in North Carolina

Clostridium difficile causes nearly 500 000 annual infections in the USA. A total of 15 000-30 000 US deaths annually and greater than US$4.8 billion dollars are related to Clostridium difficile infection (CDI). Length of hospital stay is 2.8 -5.5 additional days and inpatient costs are estimated at US$3000-US$15 400 per episode. One major cause of CDI is misuse and overuse of antibiotics. The Centers for Disease Control and Prevention reports that 30%-50% of antibiotics prescribed in hospitals are unnecessary or inappropriate. Patients with unexplained or three or greater unformed stools in 24 hours are candidates for testing of CDI.Prior to implementation, an analysis at the local level was conducted to determine possible causes of CDI influence. Chart auditing at this urban hospital revealed that 1 out of 23 (4%) providers were treating UTIs according to hospital protocol (A. Richmond, personal communication, 6 March 2018). The standardized infection ratio in 2017, which compares the predicted to the actual infection rate, at this hospital was 1.266 for CDI. Having a solid antibiotic stewardship in place is imperative to limit antibiotic related and resistant infections. During an observational study, only one out of nine (11%) staff followed contact precaution policies at this hospital.