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

Abstract

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...

Microbiome-Related and Infection Control Approaches to Primary and Secondary Prevention of Clostridioides difficile Infections

“…Enhanced infection control programs using early detection of CDI cases, surveillance, isolation or cohorting of CDI cases, contact precautions, hand hygiene training, sporicidal disinfection of environmental surfaces, and terminal room cleaning have resulted in a decrease in CDI rates in many healthcare settings and are recommended by the Infectious Disease Society Association (IDSA) guidelines [ 29 , 30 ]. Another study initiated an infection control bundle including antibiotic stewardship, patient isolation, early detection of CDI, and increased hand washing education and found CDI rates fell from 0.3% admissions before the infection control bundle was implemented to 0.1% admissions afterward ( p = 0.035) [ 31 ].…”

Potential underreporting of treated patients using a Clostridioides difficile testing algorithm that screens with a nucleic acid amplification test

“…In response to concerns that the current NHSN CDI LabID event definition does not distinguish between colonization and infection and might influence the choice of testing strategy, the NHSN is updating its CDI surveillance definition to include any positive C. difficile test and receipt of CDI treatment. 30 The updated CDI measure, known as healthcare-facility–onset, antibiotic-treated CDI (HT-CDI), has completed validation, and if widely implemented, could improve the reporting of clinically relevant NAAT+/toxin− cases. However, this is predicated on the assumption that clinicians can determine the appropriate NAAT+/toxin− patient to treat, which remains a conundrum.…”

Implementing behavior change in healthcare epidemiology and antimicrobial stewardship: The worst that can happen is you fail

“…Antibiotic use is a well-established risk factor for CDI, and the goal of stewardship programs is to reduce unnecessary use, not eliminate all use, otherwise the hospital would fall short of meeting other benchmarks for sepsis care, surgical site infection prevention, etc. 11 As pertains to CDI, a realistic and specific deliverable of stewardship programs effectively communicated to hospital leadership is the following: “Our team will implement an electronic antibiotic time-out program to reduce excess days-of-therapy of broad-spectrum antibiotics on non-teaching services by 15% within 6 months.”…”