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CME lecture on Clostridium Difficle Infection
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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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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