The Antimicrobial Stewardship Program uses an animation video to explain why we need to be smarter about antibiotic use. (Whiteboard animation: Kryski Biomedia)

This week is Antibiotics Awareness Week and University Health Network and Mount Sinai Hospital are unveiling a new tool to tackle C. difficile, one of the most common healthcare-associated infections.

Clostridium difficile (C. difficile) is one of many types of bacteria found in the bowel. C. difficile infection occurs when antibiotics kill other bowel bacteria and allow C. difficile to overgrow. As C. difficile grows, it produces toxins. These toxins can damage the bowel, causing diarrhea and other intestinal problems.

One patient gets C. difficile every two days across Mount Sinai Hospital (MSH) and the University Health Network (UHN) and these types of cases have the potential to be fatal. The infection can spread from person to person on contaminated equipment and on the hands of doctors, nurses, other healthcare providers and visitors. The infection is highly treatable when detected early.  

"Standardizing the management and treatment of patients that have C. difficile will positively impact the adverse outcomes and relapses that can occur," says Sarah West, consultant with the Antimicrobial Stewardship Program.

The Mount Sinai Hospital-University Health Network Antimicrobial Stewardship Program (MSH-UHN ASP) Team is rolling out a C. difficile algorithm for Antibiotic Awareness Week to do just that. Antibiotic Awareness Week provides an opportunity to highlight the problem of antimicrobial resistance and promote the safe and judicious use of antimicrobials within the hospital.

C. difficile algorithm

The objective of the C. difficile algorithm is to standardize the treatment and management of patients with the infection across MSH and UHN. It's a simple tool which can be used by clinicians across differing units to be a guide to assist those caring for patients with C. difficile and to improve patient outcomes.

"The algorithm is important because the treatment and management of patients with C. difficile is a high priority patient safety concern that has been linked with ongoing critical incidents," West says.

The Antimicrobial Stewardship Team sought input from many groups ranging from Infection Prevention and Control to Patient Care Coordinators like Ingrid Daley, Patient Care coordinator at Toronto General Hospital in the Medical Surgical Intensive Care Unit. Daley says the algorithm will provide much needed coordination in dealing with C. difficile cases. 

"Previously we had to wait if we had a suspected patient with C. difficile. We would have to notify the physician, which depending on the floor, unit, or hospital could mean a lengthy wait time," says Daley.

"The algorithm is now a standardized protocol where the nurses, physicians and pharmacists have exactly what needs to be done. It provides pathways of care for the patient and what each person is responsible to do in that pathway."

Protecting patients

Standardization is not only helpful to staff, but it also protects patients.

"C. difficile is very uncomfortable for the patient. It can lead to colitis, inflammation of bowels, maybe sepsis, so you want to eliminate all those complications by treating early," Daley says.

Once a C. difficile case is identified it also requires the patient be in a private room to care for them, which can be challenging to arrange. Educating the patient's family in infection control practices such as hand hygiene and wearing protective equipment is also required.

"You may have to move half a dozen patients around just to get a private room, or move a patient who's used to that floor to another floor because there isn't enough space. It really affects all levels of care," Daley says.

How it works

The algorithm operates as a flow chart detailing the steps that need to be carried out when a C. difficile case is suspected and how to proceed based on the test result. A positive or negative result will outline different pathways for each member of the care team.

"Before the algorithm the gap was a lack of standardization. Each floor was doing something different and each hospital had different practices around C. difficile protocol," says Daley. "So this project was about standardizing the process for early recognition and early treatment and bridging together any gaps to prevent new cases."

An e-learning course is available for clinicians to become familiar with the algorithm and it will officially launch on November 17, 2014.

Nov.17-21 is Antibiotics Awareness Week.  For more information about the UHN-MSH Antimicrobial Stewardship, click here.

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