Prevention of Hospital-Onset Clostridium difficile Infection in the New York Metropolitan Region Using a Collaborative Intervention Model

Koll, Brian; Ruíz, Rafael; Calfee, David P.; Jalon, Hillary S.; Stricof, Rachel L.; Adams, Audrey; Smith, Barbara A.; Shin, Gina; Gase, Kathleen A.; Woods, Maria K.; Sirtalan, I.

doi:10.1111/jhq.12002

Cited by 28 publications

(34 citation statements)

References 25 publications

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“…Only 2 studies (12%) reported pathogen acquisition as a primary outcome (83, 90). Clinical infection was reported as a primary and secondary outcome in 3 (80, 83, 90) and 2 (75, 76) studies, respectively. With regard to pathogen type, C. difficile and VRE were the primary focus of 3 (75, 80, 81) and 2 (85, 90) studies, respectively.…”

Section: Resultsmentioning

confidence: 99%

“…Three studies (18%) (75, 76, 80) used multicomponent strategies to prevent C. difficile infections and reported positive findings. Five studies (64, 76, 81, 84, 87) reporting on sustainability of preventive strategies described ongoing education, direct feedback, and commitment and flexibility of administrative leaders as key components to successful implementation.…”

Section: Resultsmentioning

confidence: 99%

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Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections

et al. 2015

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The cleaning of hard surfaces in hospital rooms is critical for reducing health care–associated infections. This review describes the evidence examining current methods of cleaning, disinfecting, and monitoring cleanliness of patient rooms, as well as contextual factors that may affect implementation and effectiveness. Key informants were interviewed, and a systematic search for publications since 1990 was done with the use of several bibliographic and gray literature resources. Studies examining surface contamination, colonization, or infection with Clostridium difficile, methicillin-resistant Staphylococcus aureus, or vancomycinresistant enterococci were included. Eighty studies were identified—76 primary studies and 4 systematic reviews. Forty-nine studies examined cleaning methods, 14 evaluated monitoring strategies, and 17 addressed challenges or facilitators to implementation. Only 5 studies were randomized, controlled trials, and surface contamination was the most commonly assessed outcome. Comparative effectiveness studies of disinfecting methods and monitoring strategies were uncommon. Future research should evaluate and compare newly emerging strategies, such as self-disinfecting coatings for disinfecting and adenosine triphosphate and ultraviolet/fluorescent surface markers for monitoring. Studies should also assess patient-centered outcomes, such as infection, when possible. Other challenges include identifying high-touch surfaces that confer the greatest risk for pathogen transmission; developing standard thresholds for defining cleanliness; and using methods to adjust for confounders, such as hand hygiene, when examining the effect of disinfecting methods.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Cleaning Hospital Room Surfaces to Prevent Health Care–Associated Infections

et al. 2015

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“…25,28,29 In our baseline scenario, patients who became colonized and diseased within the hospital ward represented, on average, 50% of the possible HO-CDI cases. Those colonized on admission have been considered to be at lower risk for subsequent onset of disease than those not colonized.…”

Section: Discussionmentioning

confidence: 99%

Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Lanzas

Dubberke

2014

Infect. Control Hosp. Epidemiol.

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ObjectiveBoth asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions.MethodsWe developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission.ResultsIn our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%–50% and 10%–25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy.ConclusionsTesting for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

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“…In the UK, the frequency of Table 1 Overall incidence of C difficile episodes, incidence in A-ICUs, and incidence in the remaining hospital units [19]. Previous studies have suggested the efficacy of specific infection control measures in reducing the incidence of CDI [20][21][22]. Rapid diagnosis of CDI is essential to improve patient outcome and prevent disease transmission.…”

Section: Discussionmentioning

confidence: 99%