Erfolgreiches Bündel von Präventionsmaßnahmen bei hoher CDAD-Inzidenz in einem Universitätsklinikum

Background: Recently, dramatically increasing nosocomial C. difficile associated disease (CDAD) infection rates were reported from many hospitals. Consequently the question of "how to prevent" is of utmost importance. Here, we show the effectiveness of a hospital-wide intervention program. Methods: Between May 2007 and April 2008 the following infection control measures were introduced: analysis of the epidemiological situation (2000-2007), use of disinfectants effective against C. difficile and increase of frequency of environmental cleaning of private rooms, a prospective surveillance for CDAD and an education program for medical staff. Sensitivity values of three different culture media were determined analysing 256 consecutive stool samples. Results: Between 2000 and 2006 a significant increase of CDAD cases occurred. No further increase occurred in 2007. Among eleven different wards, which were identified to habour significantly more cases than the remainders, eight of them significantly reduced nosocomial CDAD acquisition during the intervention program. Three different culture media yielded a sensitivity for the detection of C. difficile In 256 stool samples of 70%, 74 %, and 89 %, respectively. The addition of the most sensitive culture medium to the microbial diagnostic doubled the sensitivity of detection of Toxin A or B producing C. difficiles stool samples. Conclusion: Even after increasing the sensitivity for detection of C. difficile by 100%, hospital-wide a further increase of CDAD cases was stopped. Our data show the effectiveness of a bundle of inventions for the infection control of nosocomial CDAD.