Review - Document Details


Review - Reviewer's Assessment

1. Short summary / abstract
The report was produced for infection control teams, consultants in communicable disease control and clinicians in response to a steady rise in the number of clostridium difficile infections and prolonged outbreaks in hospitals over the decade preceding the guidance. The report outlines the nature and epidemiological trends plus cost of infections caused by C. difficile and the current knowledge available.
General guidance is given on antibiotic policies due to the importance and impact that antibiotic treatment has in predisposing patients to C. difficile, and the importance of informed decision making using clear case definitions to correctly recognise and manage an outbreak is stressed.
The chapter on prevention and control includes guidance on ensuring that patients do not become susceptible through disruption of their normal gut flora and on preventing cross infection/outbreaks as far as possible.
Laboratory investigation of C. difficile-associated diarrhoea both of sporadic cases and as routine diagnosis and investigation of an outbreak are included.
An appendix with recommended infection control procedures to prevent transmission of C. difficile infection in clinical areas forms a useful basis for local guidelines and policy.

2. What question is the document addressing?
The guidance is a useful tool for healthcare establishments to inform local policy on the management of an outbreak, development of policies for the management of individual cases of C. difficile infection and to contribute to the development of effective antibiotic prescribing policies.

3. Type of study
Review of literature, practical experience and expertise

4. Methods valid & appropriate?

The evidence pertaining to the diagnosis and control of Clostridium difficile associated disease (CDAD) has been reviewed and updated by the Department of Health National Clostridium difficile Standards Group.(2004) This report informs the reporting of cases of CDAD as part of a systematic national alert organism, laboratory reporting system – an extension of the national healthcare associated infection surveillance initiative, which includes the mandatory surveillance of staphylococcus aureus bacteraemia.

5. Results / recommendations reliable?
Yes: The report is based on information derived from an extensive review of the literature and practical experience of the member group.

6. Any major problems and biases?
Published research to inform this report was lacking in the areas of pathogenesis and modes of spread of the infection.

7. Any other important / relevant studies which confirm or contradict?
National Clostridium difficile Standards Group Report to the Department of Health. The Journal of Hospital Infection (2004)56; 1-38 (Supplement 1)

8. Keywords
Clostridium difficile antibiotic policy infection control colonised diarrhoea screening hygiene

Reviewer's Details:

Name:Sue Wiseman
Post:Nurse Consultant –Infection Control, DH
(Society / Organisation / Advisory Committee):
Member Advisory Committee on Dangerous Pathogens
Health Protection Adviser Royal College of Nursing P/T
Member Infection Control Nurses Association

*** Note: These are the views of a professional expert rather than an official statement from his or her society, organisation or advisory committee.

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