Improvement of management and reduction in mortality following implementation of audit recommendations for Clostridium difficile diarrhoea.

Normal.dotm 0 0 1 289 1706 Brett Doleman 47 11 2024 12.0 0 false 18 pt 18 pt 0 0 false false false /* Style Definitions */ table.MsoNormalTable {mso-style-name:"Table Normal"; mso-tstyle-rowband-size:0; mso-tstyle-colband-size:0; mso-style-noshow:yes; mso-style-parent:""; mso-padding-alt:0cm 5.4pt 0cm 5.4pt; mso-para-margin:0cm; mso-para-margin-bottom:.0001pt; mso-pagination:widow-orphan; font-size:12.0pt; font-family:"Times New Roman"; mso-ascii-font-family:Cambria; mso-ascii-theme-font:minor-latin; mso-fareast-font-family:"Times New Roman"; mso-fareast-theme-font:minor-fareast; mso-hansi-font-family:Cambria; mso-hansi-theme-font:minor-latin; mso-bidi-font-family:"Times New Roman"; mso-bidi-theme-font:minor-bidi; mso-ansi-language:EN-US;} Aims Clostridium difficile is a gram-positive anaerobe, which causes severe hospital-acquired diarrhoea. It has an incidence of 18 005 cases per year in England (2011-2012) and a 30-day mortality of 32.5% in one north of England NHS Trust. The aim of this audit was to improve the management of C. difficile diarrhoea in the following management standards, which are based on Department of Health best practice: 1) The severity of the disease should be documented 2) Antibiotics should be correctly prescribed 3) All patients should have a Bristol Stool Chart completed daily 4) P redisposing antibiotics should be stopped if appropriate Methods Details were provided of all 38 in-patent cases between September to December 2010 and information collated from case notes retrospectively. Following implementation of audit recommendations, 26 in-patient cases were reviewed from July to December 2011. Implementations included redesigning the Trust management algorithm, disseminating results at various professional meetings and instigating a multidisciplinary team ward round to review all patients with a positive C. difficile toxin test. This weekly ward round comprised an infectious diseases consultant, infection control nurses and an antibiotic pharmacist. The role of the ward round was to ensure that various aspects of patient management were optimised. Results Following these implementations, standards two and four improved to 100% from 86% and 84% respectively. In addition, standard one improved from 23% to 87%. No improvement was achieved in standard three, which decreased from 46% to 39%. Furthermore, in-patient mortality from C. difficile diarrhoea fell from 25% (April 2009-January 2011) to 15% (February 2011-July 2012) following these implementations. Conclusions In conclusion, this audit has demonstrated that the above implementations can improve the management of C. difficile diarrhoea and improve mortality from the disease. However, the influence of confounding variables cannot be excluded in this audit.