1. Clostridium difficile Target • Targets have been set for both acute trusts and SHAs • To reflect that it is a whole health economy issue • Target for acute trusts is 4 cases per 1,000 admissions by 2010/11. • To meet this UHMBT needs to reduce the incidence of C. difficile by appx 100 cases/year. • Meeting this target will require investment • Recent announcements around the “Clean Safe Care” policy document suggest that money has been identified by DH for this

2. Spread in hospital Symptomatic patient with diarrhoea +++ Antibiotic control Direct patient-patient spread Spread via healthcare staff Spread via environmental contamination Antibiotics (PPIs, opiates, bowel surgery also increase risk) Prompt isolation Hand hygiene and PPE Effective cleaning Colonised patients

3. Antibiotic control • Encourage discussion to ensure prescriptions are fully completed • Increase Pharmacists on wards. • Dedicated antibiotic pharmacists • Risks of different antibiotics vary depending on local strains, so local advice essential. • Draft guidelines stipulate weekly ward rounds of all C difficile patients by a microbiologist + physician + ICN + antibiotic pharmacist

4. Prompt isolation • Patients isolated as soon as symptoms appear • Patients with diarrhoea should have priority for single rooms • Increase single room accommodation

5. Hand hygiene • Appoint hand hygiene coordinator • Temporary post funded by DH money. • Audit, • Use as educational and improvement tool. • Discipline staff who fail to wash hands • Precedent already set in other trusts.

6. Effective cleaning • Increase number of cleaners • Make wards easier to clean • Consider the introduction of chlorine-based cleaning agents for general cleaning. • Make sure that equipment can be easily cleaned, and that equipment that cannot be cleaned is replaced. E.g. • Commodes • Mattresses