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.