No abstract

This study identified the previously underrecognized CDAD risk factors of CDAD pressure and vancomycin. More studies are needed to evaluate the relationship between CDAD, these risk factors, and use of gastric acid suppressors and fluoroquinolones.

Objective. To evaluate healthcare workers’ (HCWs) risk of self-contamination when donning and doffing personal protective equipment (PPE) using fluorescence and MS2 bacteriophage. Design. Prospective pilot study. Setting. Tertiary care hospital. Participants. 36 HCWs: 18 donned/doffed contact precautions (CP) PPE and 18 donned/doffed Ebola virus disease (EVD) PPE. Interventions. HCWs donned PPE according to standard protocols. Fluorescent liquid and MS2 bacteriophage were applied to HCWs. HCWs then doffed their PPE. After doffing, HCWs were scanned for fluorescence and swabbed for MS2. MS2 detection was performed using reverse transcriptase PCR. The donning and doffing processes were videotaped and protocol deviations were recorded. Results. 27% of EVD PPE HCWs and 50% of CP PPE HCWs made ≥1 protocol deviation while donning. 100% of EVD PPE HCWs and 67% of CP PPE HCWs made ≥1 protocol deviation while doffing (p=0.02). The median number of doffing protocol deviations among EVD PPE HCWs was 4, vs. 1 among CP PPE HCWs. 15 EVD PPE protocol deviations were committed by doffing assistants and/or trained observers. Fluorescence was detected on 8 (44%) of EVD PPE HCWs and 5 (28%) CP PPE HCWs, most commonly on hands. MS2 was recovered from 2 (11%) EVD PPE HCWs and 3 (17%) CP PPE HCWs. Conclusions. Protocol deviations were common during both EVD and CP PPE doffing, and some deviations during EVD PPE doffing were committed by the HCWs’ doffing assistant and/or trained observer. Self-contamination was common. PPE donning/doffing are complex and deserve additional study.

We conducted a retrospective cohort study to compare Clostridium difficile–associated disease rates determined by C. difficile–toxin assays and International Classification of Diseases, 9th Revision (ICD-9) codes. The correlation between toxin assay results and ICD-9 codes was good (κ = 0.72, p<0.01). The sensitivity of the ICD-9 codes was 78% and the specificity was 99.7%.

Background. The incidence of Clostridium difficile-associated disease (CDAD) is increasing. There are few data on the short-term and long-term attributable costs of CDAD. The objective of this study was to determine the acute and 180-day attributable inpatient costs of CDAD.Methods. We performed a retrospective cohort study of all patients without operating room costs who were admitted for у48 h to Barnes-Jewish Hospital, a tertiary care hospital in St. Louis, Missouri, 1 January 2003-31 December 2003 ( ). Attributable costs of CDAD were determined by multivariable linear regression and n p 24,691 propensity-score matched-pairs analyses ( ) for the hospitalization in which CDAD occurred and per patient n p 684 over a 180-day period, including the initial hospitalization.Results. CDAD was associated with $2454 (95% confidence interval, $2380-$2950; increase in cost, 41%) attributable costs per CDAD episode by linear regression and with $3240 attributable costs ( ; increase in P ! .001 cost, 33%) by propensity-score matched-pairs analysis. CDAD was associated with $5042 (95% confidence interval, $3797-$6481; increase in cost, 53%) attributable inpatient costs over 180 days by linear regression and with $7179 attributable costs for inpatient care ( ; 48% increase in costs) by propensity-score matched-pairs analysis. P ! .001 Conclusions. CDAD was associated with a significant increase in costs for inpatient care and increased costs at 180 days after the initial hospitalization when the CDAD episode occurred.