Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients

Abstract

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient’s health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital’s technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient’s stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.

Detection and Analysis of Clostridioides difficile Spores in a Hospital Environment

“…Studies demonstrate that there is a problem in hospitals with protecting hospitalised patients against nosocomial infections, and even with deaths caused by these infections, as confirmed by the literature data [ 25 , 26 , 27 , 28 , 29 ]. In total, in all the hospital wards in the studied facility, there were 75 patients infected with C. difficile spores in 2019 and 74 patients in 2020, of which death with a C. difficile nosocomial infection occurred in 14 (18.6%) hospitalised patients in 2019 and in 15 (20.2%) in 2020.…”

“…C. innocuum spores were detected on a ventilation grate in the ICU, and according to the literature, heating, ventilation and air conditioning (HVAC) equipment is very susceptible to the accumulation of contaminants and disease-causing pathogens [ 27 , 46 , 47 ]. C. innocuum has natural resistance to vancomycin and may cause C. difficile -related diarrhoeal infection [ 40 , 41 ].…”

“…In the many years of our studies, we have concentrated on the hospital environment surrounding the patient, the hygiene of medical personnel and general hospital hygiene, which are only some of the causes of HAIs. In our studies we would like to demonstrate that these causes have a significant impact on patient safety, and also that incorrect organisation of infection risk management can be encountered in medical facilities in Poland [ 1 , 15 , 26 , 27 , 30 , 42 ].…”