the colossal impact of clostridium difficile infection
DESCRIPTION
CME lecture on Clostridium Difficle InfectionTRANSCRIPT
![Page 1: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/1.jpg)
The Colossal Impact of Clostridium Difficile Infection
Introduction amp Epidemiology
Introduction amp Epidemiology
Introduction amp Epidemiology
Health officials now rank C diff on par with MRSA
as one of the top two infections acquired in hospitals
bull Decreasing Prevalence of CDI at the
NAH since the launch of
Antimicrobial Stewardship Program
Switch over to PCR- Lab testing amp
Tighter Infection Control measures
National average is 7ndash26 among
adult inpatients in acute care facilities
Courtesy
Syed Ali
Laboratory Director
Debbie Graham
Infection Control
Jillian Baranggay
Quality Improvement
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 2: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/2.jpg)
Introduction amp Epidemiology
Introduction amp Epidemiology
Introduction amp Epidemiology
Health officials now rank C diff on par with MRSA
as one of the top two infections acquired in hospitals
bull Decreasing Prevalence of CDI at the
NAH since the launch of
Antimicrobial Stewardship Program
Switch over to PCR- Lab testing amp
Tighter Infection Control measures
National average is 7ndash26 among
adult inpatients in acute care facilities
Courtesy
Syed Ali
Laboratory Director
Debbie Graham
Infection Control
Jillian Baranggay
Quality Improvement
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 3: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/3.jpg)
Introduction amp Epidemiology
Introduction amp Epidemiology
Health officials now rank C diff on par with MRSA
as one of the top two infections acquired in hospitals
bull Decreasing Prevalence of CDI at the
NAH since the launch of
Antimicrobial Stewardship Program
Switch over to PCR- Lab testing amp
Tighter Infection Control measures
National average is 7ndash26 among
adult inpatients in acute care facilities
Courtesy
Syed Ali
Laboratory Director
Debbie Graham
Infection Control
Jillian Baranggay
Quality Improvement
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 4: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/4.jpg)
Introduction amp Epidemiology
Health officials now rank C diff on par with MRSA
as one of the top two infections acquired in hospitals
bull Decreasing Prevalence of CDI at the
NAH since the launch of
Antimicrobial Stewardship Program
Switch over to PCR- Lab testing amp
Tighter Infection Control measures
National average is 7ndash26 among
adult inpatients in acute care facilities
Courtesy
Syed Ali
Laboratory Director
Debbie Graham
Infection Control
Jillian Baranggay
Quality Improvement
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 5: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/5.jpg)
bull Decreasing Prevalence of CDI at the
NAH since the launch of
Antimicrobial Stewardship Program
Switch over to PCR- Lab testing amp
Tighter Infection Control measures
National average is 7ndash26 among
adult inpatients in acute care facilities
Courtesy
Syed Ali
Laboratory Director
Debbie Graham
Infection Control
Jillian Baranggay
Quality Improvement
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 6: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/6.jpg)
Case Definition of CDI
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 7: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/7.jpg)
Measurement Outcome
Categorize Cases by location and time
of onsetdagger
Admission Discharge
lt 4 weeks 4-12 weeks
HO CO-HCFA Indeterminate CA-CDI
Time
2 d gt 12 weeks
HO Hospital (Healthcare)-Onset
CO-HCFA Community-Onset Healthcare Facility-Associated
CA Community -Associated
Depending upon whether patient was discharged within previous 4 weeks CO-HCFA vs CA
dagger Onset defined in NHSN LabID Event by specimen collection date
Modified from CDAD Surveillance Working Group Infect Control Hosp Epidemiol 200728140-5
Day 1 Day 4
Standardized Case Definitions for Surveillance
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 8: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/8.jpg)
Sunenshine et al Cleve Clin J Med 200673187-97
Pathogenesis of CDI
4 Toxin A amp B Production
leads to colon damage
+- pseudomembrane
1 Ingestion
of spores transmitted
from other patients
via the hands of healthcare
personnel and environment
2 Germination into
growing (Vegetative)
Form)
3 Altered lower intestine flora
(due to antimicrobial use) allows
proliferation of
C difficile in colon
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 9: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/9.jpg)
Risk Factors of CDI
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 10: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/10.jpg)
Risk Factors of CDI
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 11: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/11.jpg)
Changing Epidemiology of CDICA-CDAD (NAP1BI027-The Hypervirulent strain)
NAP1
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 12: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/12.jpg)
C diffrsquo Detectives Track a Murderous Global Microbe
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 13: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/13.jpg)
Routes of Transmission Epidemiology of Colonization and Infection
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 14: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/14.jpg)
Clinical Manifestations
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 15: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/15.jpg)
Clinical Manifestations
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 16: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/16.jpg)
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 17: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/17.jpg)
DiagnosisWhat is the Best Testing Strategy to Diagnose CDI
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 18: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/18.jpg)
DiagnosisSpecimen Collection and Transport
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 19: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/19.jpg)
Diagnosis of CDI
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 20: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/20.jpg)
Diagnosis of CDI
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 21: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/21.jpg)
Management of CDI
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 22: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/22.jpg)
CT Findings bullbowel wall thickening (most common)
bullCT equivalent to thumbprinting
bullaccordion sign
bullshaggy mucosal outline
bullpericolic stranding
bullperitoneal free fluid
bullalthough typically the whole colon is
involved the right colon and transverse colon
may be affected in isolation in up to 5 of
cases 2
bullrectal involvement in the vast majority of
cases (90-95)
Management of CDI
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 23: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/23.jpg)
Treatment of CDISurgical options
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 24: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/24.jpg)
Oral Vancomycin Taper In managing multiple
relapsers
It consists of 125 mg four times
daily for 14 days
then 125 mg bid for 7 days 125
mg once daily for 7 days 125
mg once every other day for 8
days and finally
125 mg once every 3 days for
15 days
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 25: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/25.jpg)
Cost Comparison
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 26: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/26.jpg)
Additional amp Adjuvant Therapy
bull Fidaxomicin
bull Rifaximin or Rifampin-
bull Nitazoxanide
bull Monoclonal antibodies-
bull Intravenous immune globulin (IVIG)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 27: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/27.jpg)
Treatment of Recurrent CDIFecal Microbiota Transplant (FMT)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 28: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/28.jpg)
Use of Probiotics
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 29: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/29.jpg)
Infection Control and PreventionSurveillance amp Tracking
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 30: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/30.jpg)
Core Prevention Strategies
httpwwwcdcgovncidoddhqpid_CdiffFAQ_HCPhtmlDubberke et al Infect Control Hosp Epidemiol 200829S81-92
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 31: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/31.jpg)
Prevention Strategies Supplemental
C difficile can survive on a dry surface for 60 days
Alcohol-based hand sanitizers (Purell)- Do Not kill CDiff spores
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 32: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/32.jpg)
Infection Control = Antimicrobial Control
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 33: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/33.jpg)
Antimicrobial Stewardship ProgramNorwegian American Hospital
Implement Evidence-Based Practices to Prevent Emergence
amp Improve Management of C Difficile Infection
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 34: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/34.jpg)
Antibiogram
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 35: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/35.jpg)
1
62
5
27
58
1
Discontinue Redundant Coverage
Add Appropriate Cover for Culture
Narrow Spectrum of Activity
Discontinued with AntibioticPrescription
IV to PO Switch Made
Dosing Changed
ID Consult Suggested
Antimicrobial StewardshipInterventions Performed
Antimicrobial Stewardship
Intervention Acceptance Rates
94
6
0
10
20
30
40
50
60
70
80
90
100
Annual Totals
RecommendedInterventionsPerformed
RecommendedInterventions notPerformed
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 36: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/36.jpg)
Days of Doses Dispensed Continuation of Therapy
Courtesy Charlene Hope Pharm D Maali Haleh Pharm D and PampT Dept
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 37: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/37.jpg)
Improvement in the Treatment of Clostridium Difficile Infection
Issues Identified
bull Lab
bull Pharmacy
bull Physicians
Interventions Implemented
bull Lab
bull Pharmacy
bull Physicians
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH
![Page 38: The colossal impact of clostridium difficile infection](https://reader034.vdocuments.us/reader034/viewer/2022042715/559442d81a28abee2f8b462e/html5/thumbnails/38.jpg)
References
httpwwwcdcgovHAIorganismscdiffCdiff_faqs_HCPhtml
httpwwwuptodatecomcontentsclostridium-difficile-in-adults-treatment
httpjamajamanetworkcomarticleaspxarticleid=1916296
httpwwwplosoneorgarticleinfo3Adoi2F1013712Fjournalpone0105454
Special Thanks To Infection Control Quality Improvement Laboratory amp Pharmacy departments at NAH