Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

Dancer, S.J.; Kirkpatrick, Peter; Corcoran, Deborah; Christison, Fraser; Farmer, Douglas G.; Robertson, Chris

doi:10.1016/j.ijantimicag.2012.10.013

Cited by 134 publications

(94 citation statements)

References 18 publications

(23 reference statements)

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“…Severe restrictions on first-line use of cephalosporins and quinolones in a district general hospital reduced acquisition of nosocomial C. difficile by 77% (2.398 to 0.549 cases/1,000 patient beds) (70). The antibiotic policy resulted in an immediate decrease in CDI without any additional infection control interventions.…”

Section: Difficilementioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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SUMMARY There is increasing interest in the role of cleaning for managing hospital-acquired infections (HAI). Pathogens such as vancomycin-resistant enterococci (VRE), methicillin-resistant Staphylococcus aureus (MRSA), multiresistant Gram-negative bacilli, norovirus, and Clostridium difficile persist in the health care environment for days. Both detergent- and disinfectant-based cleaning can help control these pathogens, although difficulties with measuring cleanliness have compromised the quality of published evidence. Traditional cleaning methods are notoriously inefficient for decontamination, and new approaches have been proposed, including disinfectants, steam, automated dispersal systems, and antimicrobial surfaces. These methods are difficult to evaluate for cost-effectiveness because environmental data are not usually modeled against patient outcome. Recent studies have reported the value of physically removing soil using detergent, compared with more expensive (and toxic) disinfectants. Simple cleaning methods should be evaluated against nonmanual disinfection using standardized sampling and surveillance. Given worldwide concern over escalating antimicrobial resistance, it is clear that more studies on health care decontamination are required. Cleaning schedules should be adapted to reflect clinical risk, location, type of site, and hand touch frequency and should be evaluated for cost versus benefit for both routine and outbreak situations. Forthcoming evidence on the role of antimicrobial surfaces could supplement infection prevention strategies for health care environments, including those targeting multidrug-resistant pathogens.

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Section: Difficilementioning

confidence: 99%

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

2014

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“…32 Reductions in third generation cephalosporin use have resulted in reductions in hospital CDI, and institutional C. difficile rates provide a useful outcome measure for the effectiveness of local AMS. 33 For individual patients, persistent antibiotic use increases the risk of subsequent CDI recurrences. 34 A seven-to ten-fold increased risk of recurrent CDI is reported in the first month following antibiotic cessation and a three-fold increased risk is sustained for a further 2 months.…”

Section: Antibiotic Use and Active C Difficile Infectionmentioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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Healthcare‐acquired infections (HAI) impact on patient care and have cost implications for the Australian healthcare system. The management of HAI is exacerbated by rising rates of antimicrobial resistance (AMR). Health‐care workers and a contaminated hospital environment are increasingly implicated in the transmission and persistence of multi‐resistant organisms (MRO), as well as other pathogens, such as Clostridium difficile. This has resulted in a timely focus on a range of HAI prevention actions. Core components include antimicrobial stewardship, to reduce overuse and ensure evidence‐based antimicrobial use; infection prevention strategies, to control MRO – particularly methicillin‐resistant Staphylococcus aureus (MRSA), vancomycin‐resistant Enterococcus spp. (VRE) and, more recently, multi‐resistant Gram‐negative bacteria; enhanced institutional investment in hand hygiene; hospital cleaning and disinfection; and the development of prescribing guidelines and standards of care. AMR surveillance and comparisons of prescribing are useful feedback activities once effectively communicated to end users. Successful implementation of these strategies requires cultural shifts at local hospital level and, to tackle the serious threat posed by AMR, greater co‐ordination at a national level. HAI prevention needs to be multi‐modal, requires broad healthcare collaboration, and the strong support and accountability of all medical staff.

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“…Like cleaning, stewardship is easier to implement than hand hygiene, and it has a rapid and measurable impact on resistance rates of hospital pathogens, including Clostridium difficile. [56,57] Provided one can safely discard the possibility of septic shock, it is entirely justifiable to terminate an antibiotic cocktail for a patient with persistent infection. Re-culturing specimens without the pressure from potent antibiotics means that the laboratory has a chance of isolating the pathogen and thus improves future therapeutic choice.…”

Section: Best Practice Based On Current Evidencementioning

confidence: 99%

Infection control: Evidence-based common sense

Dancer

2016

Infection, Disease & Health

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Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus

Cited by 134 publications

References 18 publications

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Controlling Hospital-Acquired Infection: Focus on the Role of the Environment and New Technologies for Decontamination

Healthcare‐acquired infections: prevention strategies

Infection control: Evidence-based common sense

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