Effectiveness of Environmental and Infection Control Programs to Reduce Transmission of Clostridium difficile

Apisarnthanarak, Anucha; Zack, Jeanne E.; Mayfield, Jennie; Freeman, J. D.; Dunne, William M.; Little, J R; Mundy, Linda M.; Fraser, Victoria J.

doi:10.1086/422523

Cited by 46 publications

(19 citation statements)

References 9 publications

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“…The majority of patients affected during the outbreak were exposed to 1 or more risk factors, such as host factors (eg, advanced age and comorbidities), 3 ' 22 exposure to factors that disrupt the normal protective intestinal microflora (ie, broad-spectrum antibiotics), 23 " 25 the use of gastric acid-suppressive agents, 26 " 28 and poor infection control practices (eg, relating to the healthcare environment, and healthcare workers' compliance with hand hygiene). 3,29 Auditing of compliance for adequate environmental cleanliness and antibiotic stewardship before the outbreak occurred showed that these practices were suboptimal. 30 ' 31 The analysis of the ribotyped C. difficile isolates (during the outbreak period) showed that ribotype 027 was the most frequendy identified strain (41% of isolates), highlighting the predominance of this ribotype in the outbreak.…”

Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

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Objective.To report a large outbreak ofClostridium difficileinfection (CDI; ribotype 027) between June 2007 and August 2008, describe infection control measures, and evaluate the impact of restricting the use of fluoroquinolones in controlling the outbreak.Design.Outbreak investigation in 3 acute care hospitals of the Northern Health and Social Care Trust in Northern Ireland.Interventions.Implementation of a series of CDI control measures that targeted high-risk antibiotic agents (ie, restriction of fluoroquinolones), infection control practices, and environmental hygiene.Results.A total of 318 cases of CDI were identified during the outbreak, which was the result of the interaction betweenC. difficileribotype 027 being introduced into the affected hospitals for the first time and other predisposing risk factors (ranging from host factors to suboptimal compliance with antibiotic guidelines and infection control policies). The 30-day all-cause mortality rate was 24.5%; however, CDI was the attributable cause of death for only 2.5% of the infected patients. Time series analysis showed that restricting the use of fluoroquinolones was associated with a significant reduction in the incidence of CDI (coefficient, —0.054; lag time, 4 months;P= .003).Conclusion.These findings provide additional evidence to support the value of antimicrobial stewardship as an essential element of multifaceted interventions to control CDI outbreaks. The present CDI outbreak was ended following the implementation of an action plan improving communication, antibiotic stewardship, infection control practices, environmental hygiene, and surveillance.

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Section: Resultsmentioning

confidence: 99%

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Aldeyab

Devine

Flanagan

et al. 2011

Infect. Control Hosp. Epidemiol.

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“…The rationale for using sodium hypochlorite for environmental cleaning in our study was based on the fact that (1) several studies have used 1:100 sodium hypochlorite to control MDR A. baumannii outbreaks successfully [29][30][31][32][33], (2) existing data suggested that cleaning floors with either detergent or disinfectant did not affect nosocomial infection rates [34], and (3) a study reported that a quaternary ammonium compound was inadequate for disinfecting bathrooms and toilets [29]. In contrast, studies have suggested that hypochlorite-based environmental cleaning can be associated with a reduced incidence of hospital-acquired Clostridium difficile infection [35][36][37]. Although A. baumannii does not form spores, the persistent survival of this pathogen when desiccated is partly analogous to that of C. difficile [38].…”

Section: Discussionmentioning

confidence: 99%

A Multifaceted Intervention to Reduce Pandrug‐ResistantAcinetobacter baumanniiColonization and Infection in 3 Intensive Care Units in a Thai Tertiary Care Center: A 3‐Year Study

et al. 2008

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“…Routine use of disposable gloves, single use thermometers, hand hygiene with chlorhexidine and environmental cleaning with 10% hypochlorite solutions have significantly reduced the acquisition rates of CDAD [4,[44][45][46][47]. Beyond antibiotic exposure, risk factors for C. difficile infection include advanced age, gastrointestinal surgery, length of hospital stay, use of antineoplastic agents, enteral feedings, and the use of laxatives [4-6, 10-12, 41, 48-51].…”

Section: Clinical Epidemiologymentioning

confidence: 99%

Clostridium difficile: Emergence of Hypervirulence and Fluoroquinolone Resistance

Razavi¹,

Thatrimontrichai

Mundy

2007

Infection

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Clostridium difficile is a well-known cause of sporadic and healthcare-associated diarrhea. Multihospital outbreaks due to a single strain and outbreaks associated with antibiotic selective pressure, especially clindamycin, have been well documented. Severe cases and fatalities from C. difficile are uncommon. The recent global emergence of a hypervirulent strain containing binary toxin (Toxinotype III ribotype 027), with or without deletion in a regulatory gene (tcdC gene), together with high-level resistance to third generation fluoroquinolones, has been associated with increased morbidity and mortality. Although the defective regulatory gene locus is associated with increased toxin production in vitro, the in vivo significance of this mutation and of the binary toxin remains undefined. To date, treatment strategies have not evolved in response to the emergence of this hypervirulaent strain. We provide a critical, quantitative summary of the evolving clinical and molecular epidemiology of C. difficile along with implications relevant to future treatment strategies.

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Effectiveness of Environmental and Infection Control Programs to Reduce Transmission of Clostridium difficile

Cited by 46 publications

References 9 publications

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

Multihospital Outbreak ofClostridium difficileRibotype 027 Infection: Epidemiology and Analysis of Control Measures

A Multifaceted Intervention to Reduce Pandrug‐ResistantAcinetobacter baumanniiColonization and Infection in 3 Intensive Care Units in a Thai Tertiary Care Center: A 3‐Year Study

Clostridium difficile: Emergence of Hypervirulence and Fluoroquinolone Resistance

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