Hospital management of Clostridium difficile infection: a review of the literature

Khanafer, Nagham; Voirin, Nicolas; Barbut, Frédéric; Kuijper, Ed J.; Vanhems, Philippe

doi:10.1016/j.jhin.2015.02.015

Cited by 19 publications

(16 citation statements)

References 67 publications

(89 reference statements)

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“…Costs associated with implementation of effective surveillance and case detection methods should be assessed in light of the benefits for patients’ safety and care. Further, adequate reporting of aspects of infectious control measures is needed in future studies to identify optimum CDI control programmes (eg, dedicated personnel time, laboratory supplies, and outbreak investigations) [18]. We echo previous recommendations that future studies should adhere to the ORION statement to be able to synthesize evidence in a more transparent and consistent manner [15,18,19], thus support greater harmonisations of CDI–targeted IPC efforts.…”

Section: Resultssupporting

confidence: 51%

“…Notably, there is a need for higher quality and comparable evidence on the attributable effects of existing CDI prevention measures, especially during endemic periods [17,18,22]. Adequate surveillance and improved detection of cases require critical attention, as our review found that differences in approaches exist.…”

Section: Resultsmentioning

confidence: 98%

“…A significant protective role (overall risk ratio 0.48, 95% confidence interval CI 0.38–0.62) was found, with the strongest evidence for restrictive programmes and those with the longest duration. Similarly, another review found that ASP and environmental disinfection were the two most important IPC for CDI in hospitals [18]. …”

Section: Resultsmentioning

confidence: 99%

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Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Balsells¹,

Filipescu²,

Kyaw³

et al. 2016

Journal of Global Health

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BackgroundClostridium difficile is the leading cause of health care–associated infections. Given the high incidence of C. difficile infection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.MethodsWe identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI–targeted IPC recommendations and describe the assessment of evidence in available guidelines.ResultsWe identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long–term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported “strong” recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality.ConclusionOur review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.

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Section: Resultssupporting

confidence: 51%

Section: Resultsmentioning

confidence: 98%

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Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Balsells¹,

Filipescu²,

Kyaw³

et al. 2016

Journal of Global Health

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“…26,28 Two narrative reviews on CDI prevention and control studies similarly commented on limitations of the available literature-for example, lack of randomized controlled trials and controlled time-series designs, as well as the tendency to implement multiple strategies to control outbreaks. 40,41 As in many medical subspecialties, it is worthwhile to note that large randomized controlled trials are a relatively recent phenomenon among infection control literature. However, in the absence of high-quality evidence, poor or indirect evidence could be used, and authors should be transparent about limitations and how this impacted recommendations' development.…”

Section: Quality Appraisal Of Underlying Evidencementioning

confidence: 99%

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

Lytvyn

Mertz

Sadeghirad

et al. 2016

Infect. Control Hosp. Epidemiol.

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BACKGROUND Clostridium difficile infection (CDI) is the most common cause of hospital-acquired infectious diarrhea. OBJECTIVE To analyze the methodological quality, content, and supporting evidence among clinical practice guidelines (CPGs) on CDI prevention. DESIGN AND SETTING We searched medical databases and gray literature for CPGs on CDI prevention published January 2004-January 2015. Three reviewers independently screened articles and rated CPG quality using the Appraisal of Guidelines for Research and Evaluation II (AGREE II) instrument, composed of 23 items, rated 1-7, within 6 domains. We reported each domain score as a percentage of its maximum possible score and standardized range. We summarized recommendations, extracted their supporting articles, and rated individually the level of evidence using the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS Of 2,578 articles screened, 5 guidelines met inclusion criteria. Median AGREE II scores and interquartile ranges were: clarity of presentation, 75.9% (75.9%-79.6%); scope and purpose, 74.1% (68.5%-85.2%); editorial independence, 63.9% (47.2%-66.7%); applicability, 43.1% (19.4%-55.6%); stakeholder involvement, 40.7% (38.9%-44.4%); and rigor of development, 18.1% (17.4%-35.4%). CPGs addressed several common strategies for CDI prevention, including antibiotic stewardship, hypochlorite solutions, probiotic prophylaxis, and bundle strategies. Recommendations were often not consistent with evidence, and most were based on low-level studies. CONCLUSION CPGs did not adhere well to AGREE II reporting standards. Furthermore, there was limited transparency in moving from evidence to recommendations. CDI prevention CPGs need to better adhere to AGREE-II and be transparent in moving from evidence to recommendations, and recommendations need to be consistent with available evidence. Infect Control Hosp Epidemiol 2016;37:901-908.

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“…To disinfect environments contaminated with C. difficile , it is generally advised to use an unbuffered 1:10 dilution of hypochlorite [10]. It is known that hypochlorite does not enhance sporulation and when used for environmental disinfection leads to a significant reduction of C. difficile -associated diarrhea [11].…”

Section: Introductionmentioning

confidence: 99%

Effectiveness of various cleaning and disinfectant products on Clostridium difficile spores of PCR ribotypes 010, 014 and 027

Kenters

Huijskens

Wit

et al. 2017

Antimicrob Resist Infect Control

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BackgroundIn healthcare facilities, Clostridium difficile infections spread by transmission of bacterial spores. Appropriate sporicidal disinfectants are needed to prevent development of clusters and outbreaks. In this study different cleaning/disinfecting wipes and sprays were tested for their efficacy against spores of distinctive C. difficile PCR ribotypes.MethodsFour different products were tested; 1) hydrogen peroxide 1.5%; 2) glucoprotamin 1.5%; 3) a mixture of ethanol, propane and N-alkyl amino propyl glycine; and 4) a mixture of didecyldimonium chloride, benzalkonium chloride, polyaminopropyl, biguanide and dimenthicone as active ingredients. Tiles were contaminated with a test solution containing a concentration of 5x106CFU/ml spores of C. difficile strains belonging to PCR ribotypes 010, 014 or 027. The tiles were left to dry for an hour and then wiped or sprayed with one of the sprays or wipes as intended by the manufacturers. When products neutralized after 5 min, microbiological cultures and ATP measures were performed.ResultsIrrespective of the disinfection method, the microbial count log10 reduction of C. difficile PCR ribotype 010 was highest, followed by the reduction of C. difficile 014 and C. difficile 027. Overall, the wipes performed better than the sprays with the same active ingredient. On average, although not significantly, a difference in relative light units (RLU) reduction between the wipes and sprays was found. The wipes had a higher RLU log10 reduction, but no significant difference for RLU reduction was observed between the different C. difficile strains (p = 0.16).Conclusion C. difficile spores of PCR ribotypes 014 and 027 strains are more difficult to eradicate than non-toxigenic PCR ribotype 010. In general, impregnated cleaning/disinfection wipes performed better than ready-to-use sprays. Wipes with hydrogen peroxide (1.5%) showed the highest bactericidal activity.

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Hospital management of Clostridium difficile infection: a review of the literature

Cited by 19 publications

References 67 publications

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations

Prevention of Clostridium difficile Infection: A Systematic Survey of Clinical Practice Guidelines

Effectiveness of various cleaning and disinfectant products on Clostridium difficile spores of PCR ribotypes 010, 014 and 027

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