Reducing The Risk Of C.Diff In Hospitals

In 2014, an Ontario hospital experienced a facility-wide Clostridium difficile (C.diff) infection outbreak. Further, and suspected of being related to this, nosocomial illnesses had risen significantly behind baseline rates, alarming hospital administrators. To address these problems, improvement initiatives were undertaken with a special focus on, what the hospital termed “environmental cleaning.”

This is where Swish was brought in. Swish, a provider of cleaning solutions and equipment in Canada, was asked to assess the current cleaning processes, products, and procedures in the hospital and provide solutions to help improve cleaning results. The ultimate goals: help reduce the number of C.diff infections, as well as help lower the incidences of nosocomial illnesses.

The first step the Swish experts took was an initial assessment of the current cleaning processes. They found that a one-step cleaning and disinfecting procedure was in place. This, it was concluded, was a key contributor in the C.diff/nosocomial infection spike. (Why this is a problem will be explained later.)

Further, tests were conducted using an adenosine triphosphate (ATP) monitoring system. These tests indicated a lack of efficacy (cleaning effectiveness) in the current cleaning processes.

For instance, the ATP tests revealed counts of between 300 to as high as 1000 ATP units on high-touch hospital surfaces such as wheelchairs, bed tables, bed rails, mattresses and toilets. These numbers were dangerously high and likely a major reason for the C.diff and nosocomial infections the hospital was experiencing.

Upon completion of the initial cleaning process assessment, the Swish cleaning experts recommended the hospital switch to a two-step cleaning and disinfecting process using two specific products, PCS ECOgent Stabilized Bleach Cleaner and PCS 5000 Oxidizing Disinfectant.

By using these products and separating cleaning and disinfecting into two tasks, Swish experts explained hospital administrators the following:
 • Cleaning efficacy would increase significantly
 • Cleaning surfaces prior to disinfecting would increase the disinfectant’s ability to make direct contact with C. diff. bacteria, allowing for more effective disinfecting results
 • With these products and processes in place, other forms of bacteria and germs that might be causing the increase in nosocomial illnesses would also be killed and their threat eliminated

To further ensure the effectiveness of the products and program, an extensive, hands-on training and communication program was provided by Swish for the housekeeping personnel.

After an eight-month trial of the products and cleaning procedures recommended, a follow-up assessment was completed. The following was uncovered:
 • Using the two-step cleaning and disinfecting process, post-cleaning ATP readings were consistently under 50 units. These are far safer readings than before.
 • Overall, the hospital experienced a 64 percent decrease in C.diff cases by adopting the new process.
 • The nosocomial infection rate was also reduced, bringing the rate closer to baseline infection rates.

“What is most significant,” says Steve Everson, Infection control expert for Swish, "is the role cleaning had in turning things around. It proves once again that effective cleaning with the right tools and products does help protect public health.”