Impact of Isolating Clostridium difficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis

Xiao, Yasi; Paquet-Bolduc, Bianka; Garenc, Christophe; Gervais, Philippe; Trottier, Sylvie; Roussy, Jean-François; Longtin, Jean; Loo, Vivian G.; Longtin, Yves

doi:10.1093/cid/cix1024

Cited by 10 publications

(9 citation statements)

References 28 publications

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“…Hospital CDI transmission may decrease over time with this approach, and the proportion of patients on contact precautions for CDI may decrease over time. 135 Because asymptomatic colonization is much more frequent than healthcare facility–onset CDI, the decrease in total number of patient days on contact precautions will depend on local healthcare facility-onset CDI rates. Antibiotics to eradicate the carrier state are generally not indicated and represent an unresolved issue.…”

Section: Section 4: Recommended Strategies For CDI Preventionmentioning

confidence: 99%

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Kociolek

Gerding

Carrico

et al. 2023

Infect. Control Hosp. Epidemiol.

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Table 1. Summary of Recommendations to Prevent Clostridioides difficile Infection (CDI) Essential Practices 1. Encourage appropriate use of antimicrobials through implementation of an antimicrobial stewardship program. (Quality of evidence: MODERATE) a. Ensure appropriate use of antimicrobials for CDI treatment. b. Ensure appropriate use of non-CDI-treatment antimicrobials. 2. Implement diagnostic stewardship practices for ensuring appropriate use and interpretation of C. difficile testing. (Quality of evidence: LOW) a. Hospital infection prevention and control programs should work with their clinical microbiology laboratory to develop pre-agreed criteria for C. difficile testing, particularly if NAATs are used either as a standalone test or part of a multi-step testing algorithm. b. At minimum, C. difficile testing should be avoided in patients without clinically significant diarrhea, in those who have been tested in the prior 7 days, and in children aged <1 year. c. Ordering providers and bedside nurses should receive education about appropriate use and interpretation of C. difficile testing. d. If feasible, the electronic medical record system should be leveraged to provide computerized provider order entry support and/or monitoring for clinical testing criteria. 3. Use contact precautions for infected patients, single-patient room preferred. (Quality of evidence: LOW for hand hygiene; MODERATE for gloves; LOW for gowns; LOW for single-patient room) a. Perform hand hygiene based on CDC or WHO guidelines before and after entering the room (ie, immediately before donning and after removing personal protective equipment). b. Place patients with CDI on contact precautions to help reduce patient-to-patient spread of the organism. c. Cohorting of patients with CDI is acceptable when single private rooms are not available. d. Ensure that adequate supplies for contact precautions are readily available. e. Follow appropriate criteria for discontinuing contact precautions.4. Adequately clean and disinfect equipment and the environment of patients with CDI. (Quality of evidence: LOW for equipment; LOW for environment) a. C. difficile spores contaminate the environment in which patients are housed and the equipment used to care for them. b. Contaminated surfaces and equipment are potential reservoirs for transmission of C. difficile. c. Develop and implement protocols for disinfection of equipment and the environment. d. Dedicate noncritical patient care items, such as blood pressure cuffs, stethoscopes, and thermometers, to a single patient with C. difficile. 5. Assess the adequacy of room cleaning. (Quality of evidence: LOW) a. Work with the environmental services team to establish a process for assessing adequacy of room cleaning at a frequency that is feasible for the team.b. The process should focus on reviewing and improving cleaning/disinfection techniques. Important issues to address include proper dilution of cleaning/disinfection products, adequacy of cleaning/disinfection technique, cleaning "high-touch" surfac...

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Section: Section 4: Recommended Strategies For CDI Preventionmentioning

confidence: 99%

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Kociolek

Gerding

Carrico

et al. 2023

Infect. Control Hosp. Epidemiol.

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“…We conducted a time series analysis, common for assessing changes in hospital-acquired infections, [18][19][20] using a random-effects regression model examining: ED wait times and HA-CDI rates, limited to patients entering through the ED.…”

Section: Random-effects Regressionmentioning

confidence: 99%

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Durant

Guerrazzi-Young

2021

J Patient Saf

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ObjectiveClostridioides difficile is the most common hospital-acquired pathogen and persists in the environment for extended periods. As a common entry point for patients with diarrhea, and a setting providing fast-paced, high-volume care, emergency departments (EDs) are often sites of C. difficile contamination. This study examined the relationship between average patient wait times in the ED before admission and overall hospital-acquired C. difficile infection (HA-CDI) rates in New York State acute care hospitals.MethodsA random-effects regression analysis compared each facility’s annual average ED wait time for admitted patients with that facility’s average (HA-CDI) rates for patients entering through the ED. This model controlled for known clinical and nonclinical predictors of HA-CDI: average length of stay; case mix index; total discharges, a measure of hospital size; and percent Medicare discharges, a proxy for advanced age.ResultsEmergency department wait times had a significant and positive relationship with HA-CDI rates. Facilities experience an additional 0.002 cases of HA-CDI per 1000 patient discharges with every additional minute patients spend in the ED (P = 0.003), on average. Emergency department wait times also had the largest effect size (0.210), indicating that they explain more of the variance in HA-CDI rates for patients entering through the ED than some of the best-known predictors of HA-CDI.ConclusionsThe relationship between ED wait times and eventual HA-CDI warrants further exploration. These findings suggest efforts to reduce ED wait times for admitted patients or more rigorous environmental cleanliness strategies in the ED, as possible avenues for HA-CDI prevention.

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“…In a segmented time series analysis by Xiao et al . 9 , isolating asymptomatic carriers in addition to isolating infected patients decreased the prevalence of isolation days for C. difficile from the pre-intervention period when surveillance for asymptomatic carriers was not performed. More data on the usefulness of probiotics have emerged.…”

Section: Clostridium Difficile Infectionmentioning

confidence: 99%

Recent advances in understanding the epidemiology of healthcare-associated infections

Sreeramoju

2019

F1000Res

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Impact of Isolating Clostridium difficile Carriers on the Burden of Isolation Precautions: A Time Series Analysis

Abstract: Isolating CD carriers led to an initial increase in isolation needs that was partially compensated by a decrease in isolation needs for CDI.

Cited by 10 publications

References 28 publications

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Strategies to prevent Clostridioides difficile infections in acute-care hospitals: 2022 Update

Can Emergency Department Wait Times Predict Rates of Hospital-Acquired Clostridioides difficile Infection? A Study of Acute Care Facilities in New York State

Recent advances in understanding the epidemiology of healthcare-associated infections

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