Effect of Detecting and Isolating<i>Clostridium difficile</i>Carriers at Hospital Admission on the Incidence of<i>C difficile</i>Infections

Longtin, Yves; Paquet-Bolduc, Bianka; Gilca, Rodica; Garenc, Christophe; Fortin, Élise; Longtin, Jean; Trottier, Sylvie; Gervais, Philippe; Roussy, Jean-François; Lévesque, Simon; Ben‐David, Debby; Cloutier, Isabelle; Loo, Vivian G.

doi:10.1001/jamainternmed.2016.0177

Cited by 186 publications

(192 citation statements)

References 32 publications

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“…Admission screening is not a currently deployed strategy, and would be costly and difficult to implement. 31 However, if a dominant hypervirulent strain, with high morbidity or mortality were to emerge, changed screening paradigms may be justified.…”

Section: Environmental Controlmentioning

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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Section: Environmental Controlmentioning

confidence: 99%

Healthcare‐acquired infections: prevention strategies

Fernando

Gray

Gottlieb

2017

Internal Medicine Journal

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“…The researchers estimate the intervention prevented approximately 63 cases. 27,95 Patients with C. difficile Infection A 2009 survey of 33 acute-care hospitals in Canada identified different approaches related to the discontinuation of CP; 13 hospitals (39%) reported that CP were discontinued as soon as the patients were asymptomatic, and 19 hospitals (58%) required a period of 24-72 hours with no symptoms prior to discontinuation of CP. One hospital reported continuing CP until the end of the treatment for CDI; this hospital had the greatest percentage of positive test results (32% vs 12% for all other hospitals combined; P < .001).…”

Section: Shedding Timementioning

confidence: 99%

“…Recent data suggest that isolation of asymptomatic carriers reduced the incidence of C. difficile in the hospital setting. 27 Based on these findings, we recommend extending the duration of CP for the duration of hospitalization in settings in which control of C. difficile is not optimal despite the institution of the standard practices. At this time, evidence does not exist supporting repeat laboratory testing for C. difficile to guide decisions regarding discontinuation of CP for patients with CDI.…”

mentioning

confidence: 98%

Duration of Contact Precautions for Acute-Care Settings

Banach

Bearman

Barnden³

et al. 2018

Infect. Control Hosp. Epidemiol.

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purposeThis expert guidance document (EG) provides recommendations regarding discontinuation of contact precautions (CP) at the individual patient level in acute-care hospitals employing CP for 1 or more of the following organisms: methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant enterococci (VRE), Clostridium difficile, and multidrug-resistant Enterobacteriaceae (MDR-E), including carbapenem-resistant Enterobacteriaceae (CRE) and extended-spectrum β-lactamase (ESBL)-producing organisms. This document also provides a review of the role of molecular testing in guiding decisions pertaining to duration of CP for patients with these organisms. The guidance does not address decisions regarding the initiation of CP for any specific organism.Previously published guidelines describe components of CP and identify situations in which CP should be used; currently, however, few publications address the issue of how long CP should be maintained. At the time of publication, decisions related to implementation of CP for select, endemic organisms are made by individual facilities based on factors such as institutional epidemiology, resources, organizational priorities, and previously published guidance, and these vary widely. The SHEA Guidelines Committee (GLC) selected this topic to address when CP should be discontinued for individual patients in acute-care settings that employ CP for the aforementioned organisms.Although the organisms addressed are frequently encountered in other settings (eg, nursing homes, long-term acute-care facilities, rehabilitation centers, outpatient medical care settings), additional considerations may affect the application of these recommendations outside the acute-care hospital environment. authorsThe authors consist of current and past members of the SHEA Guidelines Committee (GLC), who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to CP, either directly or in an advisory role. intended useSpecial-topic EG documents are developed to address areas of relatively narrow scope that lack the level of evidence required for a formal guideline but are important for the provision of safe and effective healthcare. As such, systematic grading of evidence level is not provided for individual recommendations. Each EG is based on a synthesis of limited evidence, theoretical rationale, current practices, practical considerations, the opinion of the writing group, and consideration of potential harms where applicable. Within the EG, a summary list of recommendations is provided, along with their respective rationales. We also conducted a survey of the SHEA Research Network (SRN).No EG can anticipate all situations and this EG is not meant to be a substitute for individual judgment by qualified professionals. methods Expert Guidance DevelopmentThis EG follows the process outlined in the Handbook for SHEA-Sponsored Guidelines and Expert Guidance Documents. 10 The topic of duration of CP was among those proposed and ...

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“…36 In a more recent study from 2013-2015 in Montreal, 4.8% of patients screened were identified as carriers by PCR toxin assay performed on rectal swabs at time of hospitalization. 37 While it is apparent that several healthy individuals will be asymptomatically colonized with C. difficile, efficient screening for this is not well described and there is no FDA approved test for this indication. Most assays currently in use were validated on loose or watery stools and not for the well-formed stools donors would be anticipated to produce.…”

Section: Limitations Of Screening Asymptomatic Donorsmentioning

confidence: 99%

“…40,41 Offlabel rectal swab PCR testing for asymptomatic carriers has been used in at least one study. 37 However, further clinical validation of C. difficile PCR testing is urgently needed to evaluate its use for screening of asymptomatic individuals. 37 Similarly, PCR-based multiplex panels that have been developed for rapid identification of other bacterial, viral and parasitic pathogens in infectious diarrhea have been developed compared with culture of loose/watery stool specimens.…”

Section: Limitations Of Screening Asymptomatic Donorsmentioning

confidence: 99%

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

et al. 2017

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Fecal microbiota transplantation is best understood as an effective and inexpensive therapy for recurrent Clostridium difficile infection but fecal donor selection and screening should be periodically revised. Here, we review current recommendations for selection and screening of fecal donors for fecal microbiota transplantation. We recommend considering diabetes mellitus, prior cardiovascular events, and clinical healthcare exposure as fecal donor exclusion criteria until more is known about the association of these conditions with the human gut microbiome. We review the non-bacterial members of the human gut microbiome, associations of the gut microbiome with colorectal malignancies, the human gut resistome and how these may impact future donor screening recommendations. Collaboration between clinicians, clinical laboratory scientists, industry and regulatory agencies will be critically important for continued improvement in donor selection and screening.

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Effect of Detecting and IsolatingClostridium difficileCarriers at Hospital Admission on the Incidence ofC difficileInfections

Cited by 186 publications

References 32 publications

Healthcare‐acquired infections: prevention strategies

Healthcare‐acquired infections: prevention strategies

Duration of Contact Precautions for Acute-Care Settings

Challenges in fecal donor selection and screening for fecal microbiota transplantation: A review

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