Clostridum Difficile

Question 1

What is the definition of hospital-acquired CDI?

Answer 1

A CDI case with either onset of symptoms at least 48 hours following admission to the
reporting hospital or with onset of symptoms in the community within 4 weeks following
discharge from the reporting hospital.

Question 2

Why do we do a post-infection review of CD?

Answer 2

The purpose of this review is to identify any “lapses in care” as per NHS England’s requirements. This includes establishing the following:
· Were there any aspects of care that could have been done differently?
· Were there failures in policy and procedures which directly contributed to the CDI case (for example failure to follow the Trust antibiotic policy) or had an impact on the patients care delivery (for example failure to isolate on the identification of diarrhoea)?

Question 3

For a CDI post-infection review, what specific areas would you like to address?

Answer 3

A timeline should be supplied of the patient’s admission.
Including:
• patient movement (ie beds/ wards);
• all antimicrobial therapy (including which AB, dose, start and stop dates, reason for prescription, and whether appropriate and compliant with AB prescribing guidelines
Other pertinent information to gather:
• hand hygiene on the ward (are regular audits completed, any recent issues?)
• environmental and equipment cleaning
• staffing capacity including staff: patient ratios

Question 4

CDI - prevention

Answer 4

Daily review of antimicrobial prescribing by juniors
Pharmacist input
Senior review of antimicrobial prescribing
Specialty infection input for complex decisions regarding escalation.
Antimicrobial prescribing audits