Hospital-acquired diarrhoea in elderly patients: epidemiology and staff awareness

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Abstract
To determine the incidence and causes of hospital-acquired diarrhoea in a non-outbreak setting, to document how diarrhoea is defined by healthcare staff, to record staff awareness and to assess procedures to investigate and eliminate the causes. a prospective study involving active surveillance of 2600 consecutive admissions over 4 months to identify cases of hospital-acquired diarrhoea. a 218-bed university teaching hospital in Dublin, Ireland. 2600 general medical and surgical patients. occurrence, duration and causes of diarrhoea, criteria used to define cases by healthcare staff, awareness of incidence by doctors and procedures to investigate and eliminate the causes. 50 cases were identified (mean age, 70.6 years), the incidence was 1.9 per 100 admissions and it was most commonly medication-related. Diarrhoea was most commonly defined according to frequency of bowel motions and duration of symptoms; the study definition was met in 79% of cases reported by nursing staff: doctors were aware of only 36% of cases. Doctor's awareness increased significantly if diarrhoea lasted longer than 4 days (P> 0.05) or was associated with an infectious agent (PClostridium difficile (18 of 19 cases). hospital-acquired diarrhoea in elderly patients is common, overlooked and often iatrogenic. Increased awareness of the incidence and causes, good communications between healthcare staff and a more selective and rational approach to its diagnosis are needed.

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