Three different patients tested positive for Clostridium Difficile over a 3 month period. Each had attended a different clinical department within the hospice for their care. Enhancedfingerprint testing demonstrated the strains were indistinguishable PCR-ribotype 027 highly suggesting transmission within the hospice.

Method An incident meeting was held, chaired by Public Health England, to examine the rootcause analysis in detail, and action plan agreed. An external infection control audit previouslyundertaken by Department of Public Health was reviewed. Overall score was 94% against acompliance score of 84%. Environmental ATP swabbing was undertaken by the communityinfection control team, 17/18 swabs passed the criteria for cleanliness, 18thswab was borderlinefail.

Intervention Hand washing training and infection control is mandatory annually for all staff,students and volunteers, and is included as part of the new starter induction programme. Additionalin-service training about Clostridium Difficile continues. Infection control policies were updated andspecific infection control information leaflets devised and are now distributed to families.

Housekeepers receive specific infection control training. Housekeeping establishment hours havebeen increased and cleaning schedules reviewed. Disposable hoist slings and slide sheets werepurchased. Monthly audits of hand hygiene, waste, environment and sharps bins continue. Resultsare circulated to staff with action plans if necessary. An audit of Proton Pump Inhibitor and antibioticprescribing was undertaken and results presented to clinical staff. HPV fogging was recommendedand undertaken at the cost of £5000.

Outcome A score of 98% was achieved in the final external Public Health audit. The incidenthighlighted the importance of collaborative working between Hospice, NHS partners and PublicHealth England. Everyone is aware that infection control is everybody's business.