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Testing, Surveillance and Management of Clostridium Difficile

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Testing, Surveillance and Management of Clostridium Difficile Annex C: Testing, Surveillance and Management of Clostridium difficile In All Health Care Settings Provincial Infectious Diseases Advisory Committee (PIDAC) Revised: January 2013 The Ontario Agency for Health Protection and Promotion (Public Health Ontario) is a Crown corporation dedicated to protecting and promoting the health of all Ontarians and reducing inequities in health. As a hub organization, Public Health Ontario links public health practitioners, front-line health workers and researchers to the best scientific intelligence and knowledge from around the world. Public Health Ontario provides expert scientific and technical support relating to communicable and infectious diseases; surveillance and epidemiology; health promotion, chronic disease and injury prevention; environmental and occupational health; health emergency preparedness; and public health laboratory services to support health providers, the public health system and partner ministries in making informed decisions and taking informed action to improve the health and security of Ontarians. The Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC) is a multidisciplinary committee of health care professionals with expertise and experience in Infection Prevention and Control. The committee advises Public Health Ontario on the prevention and control of health care associated infections, considering the entire health care system for protection of both clients/patients/residents and health care providers. PIDAC-IPC produces “best practice” knowledge products that are evidence-based, to the largest extent possible, to assist health care organizations in improving quality of care and client/patient/resident safety. Disclaimer for Best Practice Documents This document was developed by the Provincial Infectious Diseases Advisory Committee on Infection Prevention and Control (PIDAC-IPC). PIDAC-IPC is a multidisciplinary scientific advisory body that provides evidence-based advice to the Ontario Agency for Health Protection and Promotion (Public Health Ontario) regarding multiple aspects of infectious disease identification, prevention and control. PIDAC-IPC’s work is guided by the best available evidence and updated as required. Best Practice documents and tools produced by PIDAC-IPC reflect consensus positions on what the committee deems prudent practice and are made available as a resource to public health and health care providers. Suggested Citation: Ontario Agency for Health Protection and Promotion, Provincial Infectious Diseases Advisory Committee. Annex C – Testing, Surveillance and Management of Clostridium difficile. Annexed to: Routine Practices and Additional Precautions in All Health Care Settings. Toronto, ON: Queen’s Printer for Ontario; 2013. Originally published: December 2004 Second Revision: January 2009 Third Revision: May 2010 NOTES This document is intended to provide best practices only. Health Care settings are encouraged to work towards these best practices in an effort to improve quality of care. Provincial Infectious Diseases Advisory Committee (PIDAC) Ontario Agency for Health Protection and Promotion www.oahpp.ca Tel: 647-260-7100 Email: [email protected] All or part of this report may be reproduced for educational purposes only without permission. © Queen’s Printer for Ontario, 2013 ISBN: 978-1-4606-1940-7 PIDAC: Annex C: Testing, Surveillance and Management of Clostridium difficile | January 2013 ii Annex C: Testing, Surveillance and Management of Clostridium difficile in All Health Care Settings This document is current to January 2013. New material in this revision is highlighted in mauve in the text. Summary of Major Revisions: Page Revision 1 New definition for Small Community Hospital 3 Results of mandatory reporting for C. difficile 5 Summary of IPAC measures to prevent and control CDI 6 Stronger position on accommodation for CDI 6 Recommendation for an antibiotic stewardship program 6 Further clarification of hand hygiene practice for care of clients/ patients/ residents with C. difficile 7-9 Enhanced cleaning practices for C. difficile rooms and bathrooms 9 Treatment with fidaxomicin 10 New and evolving therapies 11 Clarification of discontinuation of precautions for CDI 11 Additional direction for relapse of symptoms 12 Antibiotic stewardship 14 Availability and turnaround time for C. difficile testing 14 Molecular testing recommended as method of choice for C. difficile testing 14-16 Clarification of case definition 16 Clarification of criteria for investigating C. difficile clusters 17 Clarification of outbreak identification 18 Additional information about Infection Control Resource Teams (IRCT) 18 Additional language around CDI outbreaks 20 Additional recommendation regarding reporting gastrointestinal outbreaks 27 New Appendix B – CDI Rates in Ontario 28 New Appendix C – CDI Room Cleaning 31 Revisions to Appendix D – Patient Information Sheets 35 New Appendix E – Elements of CDI Line Listing PIDAC: Annex C: Testing, Surveillance and Management of Clostridium difficile | January 2013 iii Table of Contents Table of Contents ............................................................................................................................... iv Additional Abbreviations for this Annex ............................................................................................ 1 Glossary of Additional Terms for this Annex ...................................................................................... 1 PREAMBLE ................................................................................................................................................. 2 About This Annex................................................................................................................................ 2 BACKGROUND ........................................................................................................................................... 3 A. What are Clostridium difficile (C. difficile) and Clostridium difficile Infection (CDI)? ................. 3 B. Risk Factors for CDI ..................................................................................................................... 4 PREVENTION AND CONTROL MEASURES FOR CDI ............................................................................................... 5 A. IPAC Measures ............................................................................................................................ 5 1. Initiation of Contact Precautions ............................................................................................ 5 2. Accommodation...................................................................................................................... 5 3. Hand Hygiene ......................................................................................................................... 6 4. Environmental Cleaning.......................................................................................................... 7 5. Other Interventions to Limit C. difficile Transmission ............................................................. 8 6. Treatment of C. difficile .......................................................................................................... 9 7. Visitors .................................................................................................................................. 10 8. Patient Transfer .................................................................................................................... 10 9. Patient Discharge ................................................................................................................. 10 10. Discontinuation of Precautions for CDI ................................................................................ 11 11. Relapse of Symptoms ........................................................................................................... 11 12. Occupational Health ............................................................................................................ 11 B. Antibiotic Stewardship ............................................................................................................. 11 CDI TESTING AND SURVEILLANCE ......................................................................................................... 14 A. Testing for Diagnosis of C. difficile Infection ............................................................................ 14 B. Case Definitions for Surveillance and Reporting ...................................................................... 14 PIDAC: Annex C: Testing, Surveillance and Management of Clostridium difficile | January 2013 iv 1. Case Definition for CDI .......................................................................................................... 14 2. Surveillance Definition for Attributable CDI.......................................................................... 15 CDI OUTBREAKS ...................................................................................................................................... 17 A. Identifying a CDI Outbreak ....................................................................................................... 17 1. CDI Outbreak Thresholds ...................................................................................................... 18 2. Assessment of a CDI Outbreak.............................................................................................
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