Outbreak of Clostridium difficile Colitis at a Veterans Affairs Medical Center

ISSUE: Clostridium difficile, an anaerobic, spore-containing gram-positive bacillus produces a toxin that can result in nosocomial, antibiotic-related colitis. From August 2002 to July 2003, 30 patients with diarrhea were identified with nosocomial C. difficile colitis. In the previous 7 months, January–July 2002, one nosocomial C. difficile colitis was reported. PROJECT: A retrospective chart review of the 30 patients. RESULTS: The chart review revealed: 1) 22/30 (73%) were Surgical Service patients, 2) 8/30 (27%) were Medical Service patients, 3) broad-spectrum antibiotic therapy was the major contributing factor, 4) clustering occurred in the Surgical Intensive Care Unit and two wards, 5) 28/30 (93%) responded to standard metronidazole or oral vancomycin therapy, and 6) 2/30 (7%) resulted in bowel perforation and death. The Centers for Disease Control conservative estimated cost of the 30 infections was more than $90,000.00. Infection control measures taken to stop the outbreak and decrease transmission included: 1) educating staff on strict adherence to hand hygiene, 2) monitoring compliance with standard precautions, including gowns, for direct care activities with patients who have diarrhea, 3) meticulous cleaning of hospital room environment of patients with C. difficile colitis or diarrhea, 4) cohorting patients with C. difficile colitis, and 5) monitoring antibiotic usage patterns. Following initiation of these measures, six cases were identified between August and November 2003. LESSONS LEARNED: This outbreak emphasizes the importance, morbidity, and mortality associated with nosocomial C. difficile colitis. Hand hygiene, environmental cleaning, surveillance, and antibiotic usage continue to be high-priority methods to reduce the incidence of nosocomial C. difficile colitis.