Call to extend Clostridium difficile care bundles

Care bundles used in hospitals to tackle Clostridium difficile should be rolled out to community settings, a leading microbiologist told the Health Protection Agency's annual conference at Warwick University last week.

Bharat Patel, HPA regional microbiology network and healthcare-associated infection lead for London, said that introducing key interventions – supported by strong evidence – could significantly reduce community infection rates.

'Clostridium difficile can cause severe colitis which is extremely debilitating. We are seeing more virulent strains of the infection emerging all over the US, Europe and the UK,' he told delegates. 'What happened in hospitals cannot be allowed to be repeated in care homes.'

He highlighted the success that care bundles could have in tackling the infection, using examples in the acute sector.

The introduction of a care bundle at East Kent Hospitals NHS Trust saw the rate of C. difficile infection drop by more than 60% – from 700 cases in 2005 to 280 in 2007.

And at Barking, Havering and Redbridge Hospitals NHS Trust, rates of infection were reduced from over 900 cases in 2006 to just over 200 in 2007, following the implementation of a care bundle, Mr Patel said.

'We need to transfer good practice that has occurred in hospitals to care home settings,' he said. 'Elements such as good hand hygiene, the wearing of protective equipment, rapid isolation and enhanced environmental cleaning need to be taken on board by senior care home staff and implemented through leadership and education.'

Communication between the acute and community sectors, and infection control training for care home staff, also need to be improved, Mr Patel told delegates.

'Hospitals need to provide detailed discharge letters and instructions to care home staff who need to be aware of the picture of C. difficile at local hospitals,' he said.