The past Monday, APIC held the 2013 Clostridium difficile Educational and Consensus Conference in Baltimore, MD. Coming from Toronto, I'll say right off the
bat, it was WONDERFUL to spend 3 days at 15-16C (58 - 600F) and the crab cakes
were delicious too!
The conference was held over 2 days with the intent to
building consensus for C. difficile infection prevention and control by
providing a forum for discussion and exploration of how healthcare
professionals and government agencies can prevent and control the spread of C.
difficile to improve patient outcomes and also unveiled the new Guide to Preventing Clostridium difficile Infections (APIC 2013). Presentations covered everything from the
epidemiology of C. difficile, testing methods for detecting C. difficile,
Environmental Cleaning, Hand Hygiene and Antibiotic Stewardship.
I would be typing forever, if I tried to capture all of
the key messages that were presented, so for brevity sake the following
summarizes the real "So-What" moments that resonated with me:
1. Alcohol Based Hand Sanitizers should not be used for
Hand Hygiene unless used as an adjunct after washing ones hands with soap and
water.
2. Studies comparing differing hand hygiene products
found that many fared no better than tap water in removing C. difficile spores
and that C. difficile spores are more difficult to remove from hands than other
representative spores such as Bacillus sp.
3. Activities around the prevention and control of C.
difficile have increased, however we are not seeing a correlating decrease in
HAIs. This could be in part as often
times our prevention and control activities may focus on the low hanging fruit
and facilities that have been very successful in reducing their C. diff rates
have taken a bundle approach tackle all areas responsible for infection and
transmission (cleaning, hand hygiene, antibiotic stewardship, surveillance
etc).
4. Environmental cleaning has been a primary focus for
many facilities, however, it appears that many facilities have not contemplated
the role of nursing in cleaning and disinfection. Educating nursing staff on how to clean and
disinfect correctly is as important as training housekeeping staff.
5. Antibiotic Stewardship is a MUST!
6. When moving from the EIA (enzyme immunoassays) to NAAT
(Nucleic Acid AmplificationTest) test methods you need to expect to see an
increase in cases of C. diff. It's not
that the facility has more C. diff, but that the NAAT test method is far more
sensitive in identifying C.diff.
7. There is a dog named Cliffe that has been trained to
sniff poop and identify whether or not it contains C.diff. I kid you not!
I think Dr. Erik Dubberke summed up the whole premise of
infection prevention and control perfectly with a quote from Ralph Waldo Emerson "Do not go where the path may lead, go instead where there is no
path and leave a trail". Yes, we
have guidelines and best practices, but sometimes in preventing the spread of
infection we need to think outside of the box and not be afraid to challenge
the norm.
Bugging off!
Nicole
