Clinical audit of Clostridium difficile management

Sarah Murray; Krista Stockenhuber; Rushabh Shah; Joseph Butler; Bill Smith

doi:10.7861/clinmedicine.19-2-s121

Aims

Clostridium difficile is a serious and highly infectious colitis, often occurring as a complication in frail elderly patients in hospital and across the community. In recent decades the incidence and mortality rates from C difficile have increased, due to both virulence factors and widespread use of broad-spectrum antibiotics. There is strong evidence that good clinical care of these patients reduces morbidity, mortality and helps to limit cross-infection. In accordance with the National Institute of Health and Care Excellence and Public Health England standards, we carried out an audit to assess the clinical care of these patients on our medical wards.

Methods

An audit pro forma for data collection was developed, based on established standards. Thirty confirmed C difficile cases over a 1-year period were identified from our laboratory database and reviewed retrospectively. We developed a management pro forma to prompt good documentation and support high standards of care. A hospital-wide screensaver was designed to raise awareness, and a knowledge quiz disseminated to improve understanding among clinical staff. Eleven cases over the following 9 months were audited, using the same methods.

Results

See Table 1.

View this table:

Table 1.

Summary of results

Conclusion

We identified in our first audit cycle that C difficile management did not meet recommended standards. We implemented measures that aimed to improve knowledge, prompt excellent care and aid documentation. Re-audit demonstrated an improvement in adherence to all standards. A reduced number of cases could potentially have been associated with lower levels of cross-infection. This work has been presented at local and regional forums to disseminate knowledge. The clinical pro forma has been accepted as trust documentation and incorporated into local guidelines, accessible via the intranet. We now look to make this a sustainable change, by identifying a team to continue assessing the impact of this work.