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Background: We were alerted to increased rates of Clostridium difficile-positive tests at all 3 hospitals in our health care system by MedMined Data Mining Surveillance Service, CareFusion (San Diego, CA). In response, an intervention of terminal room cleaning with dilute bleach was instituted to decrease the amount of C difficile environmental spore contamination from patients with C difficile infection (CDI). Methods: The intervention consisted of replacing quaternary ammonium compound as a room cleaning agent with dilute bleach to disinfect rooms of patients with CDI upon discharge. All surfaces, floor to ceiling were wiped with dilute bleach applied with towels to thoroughly wet the surfaces. Daily room cleaning remained unchanged. Patients remained on C difficile contact isolation precautions until discharge. To determine the effectiveness of this program, rates of nosocomial CDI for all 3 hospitals were determined using the MedMined Virtual Surveillance Interface for 10 months prior to and 2 years after the cleaning intervention. Statistical significance was determined using Poisson regression analysis. Results: There was a 48% reduction in the prevalence density of C difficile after the bleaching intervention (95% confidence interval: 36%-58%, P < .0001). Conclusion: The implementation of a thorough, all-surface terminal bleach cleaning program in the rooms of patients with CDI has made a sustained, significant impact on reducing the rate of nosocomial CDI in our health care system. [Copyright &y& Elsevier]

Background: Between June 1, 2004, and March 14, 2005, 16 patients in the surgical/medical intensive care unit (ICU) were infected and another 2 were colonized with multidrug-resistant (MDR) Acinetobacter baumannii. We describe the systematic investigation initiated to discover an environmental reservoir and a novel measure taken to terminate the outbreak. Methods: Cultures were taken from moist areas in the ICU, including sink traps, sink and counter surfaces, drains, and faucets. Strains were characterized using restriction endonuclease analysis. A weekly full drainpipe chase cleansing protocol with sodium hypochlorite (bleach) solution for all 24 ICU and waiting room area sinks connected by common plumbing was initiated in March 2005. Results: Eleven of 16 infected patients (69%) had a clonal MDR strain, 1 patient (6%) was infected with an unrelated strain, and in 4 patients (25%) strains were not available for typing. The reservoir for the A baumannii clone was detected in a sink trap within one of the ICU patient rooms that likely represented contamination of the entire horizontal drainage system. The bleaching protocol initiated in March 2005 successfully decontaminated the reservoir and eliminated the MDR A baumannii infections. Conclusion: A systematic search for an environmental reservoir followed by decontamination significantly reduced (P < .01) the incidence of MDR A baumannii infection. [Copyright &y& Elsevier]