467. Investigation of a Clostridium difficile Infection (CDI) Outbreak in a Community Teaching Hospital

Background An abrupt change in baseline CDI from 2016 to 2017 prompted a response team task force including senior administration, the CMO, infection prevention, environmental services, laboratory, pharmacy, emergency department (ED), and nursing to address the problem. Methods Hospital-acquired (HA) and community-acquired (CA) CDI cases were tracked using an epidemic curve and institutional case mapping. A multipronged intervention was implemented that included molecular typing of isolates, quarterly terminal cleaning of the ED, improved CDI screening and testing, intensified antimicrobial stewardship (AS) with mandatory education for key clinicians, and rigorously enhanced enforcement of hand hygiene with secret observers and directed feedback. Pre-, mid-, and fully-implemented intervention HA and CA CDI rates were observed. Results Ninety-five percent of CA CDI and 98% of all patients who developed HA CDI were admitted through the ED. Cases of CDI were distributed throughout the hospital. The genotyping did not identify a single strain outbreak. Sixteen percent of all CDI samples (23% of CA and 9% of HA cases) sent to the DOH tested positive for BINAP1. Preintervention rates of HA CDI were found to be lower than mid-intervention rates (2.4, 95% CI= 1.5–3.1 vs. 4.3, 95% CI= 1.13–7.37). HA CDI rates after full-intervention in fourth quarter 2017 and first quarter 2018 trended toward baseline (2.1, 95% CI = 0–5.93) but had not achieved statistical improvement (Figure 1). A significant correlation between HA CDI rates and CA CDI rates was not found (r = 0.241, P < 0.5), suggesting that HA CDI rates were not driven by CA CDI rates. Hospital and ED hand hygiene improved significantly; hospital preintervention = 0.84 vs. intervention = 0.91, P < 0.01; ED hand hygiene preintervention = 0.72 vs. intervention = 0.86, P < 0.04. No statistically significant changes in antimicrobial use were noted. Conclusion A rapid, aggressive team-based approach for a CDI outbreak successfully reversed a rising rate and SIR. Although no one specific intervention was clearly responsible for the reversal, we did observe a statistically significant increase in hand hygiene. This outbreak and its management illustrate the importance of active surveillance and a rapid team-based response to CDI outbreaks. Disclosures All authors: No reported disclosures.