Introduction In January 2009 the Capital region of Denmark experienced for the first time an outbreak of hypervirulent Clostridium difficile PCR ribotype 027.
Methods An epidemiological investigation was launched in a regional hospital in February 2009; the Statens Serum Institut supported the hospital in the outbreak investigation and risk assessment. Considerable media attention raised awareness among other hospitals of the Region and prompted informal collaboration. Risk management was conducted by the National Board of Health, which issued guidelines to enhance surveillance of C difficile and to implement control measures.
Results In April 2009, the National Board of Health requested all Clinical Microbiology Departments to submit isolates of C difficile to the Reference Laboratory of Statens Serum Institut, if those fulfilled a set of criteria. The criteria ensured surveillance of severe C difficile infections by strain characterisation. An epidemiological study on mortality confirmed that the criteria used in the surveillance programme ensured detection of emerging and hyper virulent strains. Following discussion with Hospital Hygienic Committees, in collaboration with the Statens Serum Institut, the National Board of Health, and the Danish Working Environment Authority the recommendations of the Danish Working Environment Authority were changed and disinfection with chlorine became legal and was included as an option in the hospital hygienic guidelines of the Capital Region.
Conclusion The outbreak response including field epidemiology investigation led to rapid changes in national surveillance and policies. Involvement of different stakeholders and communication between regional and national level was the key to have these interventions happen rapidly.