Clostridium difficile infection perceptions and practices: a multicenter qualitative study in South Africa

Abstract

BackgroundClostridium difficile infection (CDI) is understudied in limited resource settings. In addition, provider awareness of CDI as a prevalent threat is unknown. An assessment of current facilitators and barriers to CDI identification, management, and prevention is needed in limited resource settings to design and evaluate quality improvement strategies to effectively minimize the risk of CDI.MethodsOur study aimed to identify CDI perceptions and practices among healthcare providers in South African secondary hospitals to identify facilitators and barriers to providing quality CDI care. Qualitative interviews (11 physicians, 11 nurses, 4 pharmacists,) and two focus groups (7 nurses, 3 pharmacists) were conducted at three district level hospitals in the Cape Town Metropole. Semi-structured interviews elicited provider perceived facilitators, barriers, and opportunities to improve clinical workflow from patient presentation through CDI (1) Identification, (2) Diagnosis, (3) Treatment, and (4) Prevention. In addition, a summary provider CDI knowledge score was calculated for each interviewee for seven components of CDI and management.ResultsMajor barriers identified were knowledge gaps in characteristics of C. difficile identification, diagnosis, treatment, and prevention. The median overall CDI knowledge score (scale 0–7) from individual interviews was 3 [interquartile range 0.25, 4.75]. Delays in C. difficile testing workflow were identified. Participants perceived supplies for CDI management and prevention were usually available; however, hand hygiene and use of contact precautions was inconsistent.ConclusionsOur analysis provides a detailed description of the facilitators and barriers to CDI workflow and can be utilized to design quality improvement interventions among limited resource settings.

Evaluation of inpatients Clostridium difficile prevalence and risk factors in Cameroon

“…5 Faculty of Health Sciences, University of Buea, PO Box 63, Buea, SW Region, Cameroon. 6 Faculty of Medicine, Xavier-Bichat Campus, University of Paris VII -Denis Diderot, Paris, France.…”

“…There are scarcity of data published and information sharing platforms on CDI epidemiology in sub-Sahara Africa [ 6 , 7 ]. Little is documented on the risk factors and prevalence of C. difficile in hospitals and community health care settings in Cameroon.…”

Application of Consolidated Framework for Implementation Research to Improve Clostridioides difficile Infection Management in South African District Hospitals

“…However, they are not always utilized, potentially due to knowledge gaps and/or a lack of awareness of the infection. 14 The rst CDI epidemiology and outcomes study was designed to serve as baseline data for the intervention and provide data on the magnitude of CDI in public district hospitals in this LMIC. The published results of the CDI epidemiology and outcomes study in South Africa pre-implementation are available.…”

“…Discrepancies in coding were discussed and resolved as previously described in our qualitative study. 14 Step excluded. We summarized collected data on the steps of CDI care provided and patient outcomes, which was later presented to each participating hospital through formal presentations and individual meetings as interest and schedules allowed.…”

“…5 12 13 We found measurable gaps in the delivery of these steps as well as CDI knowledge across healthcare providers in hospitals in the Western Cape, South Africa. 14 15 CDI interventions developed and proven in high resource settings, where most CDI epidemiological and quality improvement studies are performed, may not apply directly to low resource settings. 16 17 There is a gap in CDI literature from low resource settings, especially sub-Saharan Africa, particularly in adapting CDI interventions to low resource settings.…”