Impact of a training program on the surveillance of Clostridioides difficile infection

Abstract

A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.

Impact of the Introduction of a Two-Step Laboratory Diagnostic Algorithm in the Incidence and Earlier Diagnosis of Clostridioides difficile Infection

“…The incidence of patients diagnosed with a first episode of CDI in our center increased significantly from 0.9 to 5.5 cases per 10,000 patient-days and it is consistent with previous studies [ 4 , 7 , 10 ]. Several factors may explain this increase in the incidence of CDI in addition to the introduction of the more sensitive two-step diagnostic protocol in 2013 [ 7 , 10 , 11 , 13 ]. These factors include an augment in the population at risk and a higher index of clinical suspicion.…”

“…A surveillance study in Catalonia showed that the application of a multimodal training strategy that included an online course on CDI, two face-to-face workshops, and dissemination of recommendations on its prevention and the use of an optimal diagnostic algorithm significantly increased the incidence of CDI from 2.20 cases per 10,000 patient-days in 2011 to 3.41 in 2016 [ 11 ]. An optimal diagnostic algorithm comprises a test with high sensitivity as a screening method, such as GDH, followed by a more specific test to detect toxins either by EIA in a first step or by molecular NAAT methods in a second step.…”

Economic burden of recurrent Clostridioides difficile infection in adults admitted to Spanish hospitals. A multicentre retrospective observational study

“…The incidence rate of CDI in Spain has increased from 2.20 cases/10,000 patients in 2011 to 3.41 in 2016 [ 10 ]. C. difficile infections have a high rate of recurrence after the end of treatment, which may complicate the prognosis due to increased morbidity and mortality.…”

“…The incidence rate of CDI in Spain has increased from 2.20 cases/10,000 patients in 2011 to 3.41 in 2016 [10]. C. dif- Figure 3 shows the total cost, stratified by subgroups.…”

“…In recent decades there has been an increase in cases of diarrhoea associated with CDI, probably due to increased clinical suspicion and greater diagnostic sensitivity. According to the VINCat register (a Catalan Health Service programme that established a unified surveil-lance system for nosocomial Infections in Catalan hospitals), the incidence rate increased from 2.20 cases/10,000 hospital stays in 2011 to 3.41 in 2016 [ 10 ]. The increase was significant for all types of CDI: nosocomial, health care-related and community-acquired [ 11 ].…”