Clostridium difficile Outbreak: A Small Group of Pharmacists Makes a Big Impact

INTRODUCTIONHospitals all over Canada are realizing that Clostridium difficile can kill. The Royal Victoria Hospital in Barrie, Ontario, declared a C. difficile outbreak on February 23, 2007, after 39 new cases of C. difficile–associated disease (CDAD) were identified since the start of the year. Before this period, the baseline monthly incidence of hospital-acquired CDAD at this institution had been about 8. A subsequent external chart audit of 31 cases from September 2006 to February 2007 concluded that C. difficile had hastened or had been the primary factor in the deaths of 7 patients at the hospital and had been a contributing factor in 11 more deaths.1 In response to the outbreak, the Royal Victoria Hospital implemented a 50-point action plan, which included increasing infection control measures, such as enhancing cleaning practices, hand hygiene, and isolation precautions; extensive staff and patient education; and intensive review of antibiotic therapy for all patients at high risk of CDAD. The purpose of this paper is to describe how the pharmacy department at the Royal Victoria Hospital responded to the challenge of the outbreak, in particular by developing a program to help reduce the rate of CDAD within the hospital. Despite a reduced complement of pharmacists and minimal clinical presence on the patient care units, the pharmacy department designed and implemented clinical decision support tools, provided education, and promoted antibiotic stewardship to minimize the risk of CDAD. The leadership and clinical expertise of the pharmacy department contributed to a reduction in new cases of nosocomial CDAD at the hospital and raised awareness about the pressing nature of C. difficile infection