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Kunishima H, Ichiki K, Ohge H, Sakamoto F, Sato Y, Suzuki H, Nakamura A, Fujimura S, Matsumoto K, Mikamo H, Mizutani T, Morinaga Y, Mori M, Yamagishi Y, Yoshizawa S. Japanese Society for infection prevention and control guide to Clostridioides difficile infection prevention and control. J Infect Chemother 2024; 30:673-715. [PMID: 38714273 DOI: 10.1016/j.jiac.2024.03.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 05/09/2024]
Affiliation(s)
- Hiroyuki Kunishima
- Department of Infectious Diseases. St. Marianna University School of Medicine, Japan.
| | - Kaoru Ichiki
- Department of Infection Control and Prevention, Hyogo Medical University Hospital, Japan
| | - Hiroki Ohge
- Department of Infectious Diseases, Hiroshima University Hospital, Japan
| | - Fumie Sakamoto
- Quality Improvement and Safety Center, Itabashi Chuo Medical Center, Japan
| | - Yuka Sato
- Department of Infection Control and Nursing, Graduate School of Nursing, Aichi Medical University, Japan
| | - Hiromichi Suzuki
- Department of Infectious Diseases, University of Tsukuba School of Medicine and Health Sciences, Japan
| | - Atsushi Nakamura
- Department of Infection Prevention and Control, Graduate School of Medical Sciences, Nagoya City University, Japan
| | - Shigeru Fujimura
- Division of Clinical Infectious Diseases and Chemotherapy, Faculty of Pharmaceutical Sciences, Tohoku Medical and Pharmaceutical University, Japan
| | - Kazuaki Matsumoto
- Division of Pharmacodynamics, Faculty of Pharmacy, Keio University, Japan
| | - Hiroshige Mikamo
- Department of Clinical Infectious Diseases, Aichi Medical University, Japan
| | | | - Yoshitomo Morinaga
- Department of Microbiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Japan
| | - Minako Mori
- Department of Infection Control, Hiroshima University Hospital, Japan
| | - Yuka Yamagishi
- Department of Clinical Infectious Diseases, Kochi Medical School, Kochi University, Japan
| | - Sadako Yoshizawa
- Department of Laboratory Medicine/Department of Microbiology and Infectious Diseases, Faculty of Medicine, Toho University, Japan
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Večerková L, Mašková L, Knejzlík Z, Kašpar O, Tokárová V. Development of spray-dried powder hand sanitiser with prolonged effectivity. Sci Rep 2024; 14:4827. [PMID: 38413707 PMCID: PMC10899249 DOI: 10.1038/s41598-024-55503-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 02/24/2024] [Indexed: 02/29/2024] Open
Abstract
Since the outbreak of the COVID-19 pandemic, the use of hand sanitisers has become an inseparable part of our personal hygiene. However, the short-term effect and the need for frequent application are shortcomings that impair the overall protection. Another aspect is that repeated use of some products (typically alcohol-based) may cause skin irritation or eventually more severe health problems. This work proposes spray-drying as a suitable method for the preparation of swellable chitosan carriers, allowing for encapsulation and sustained release of antibacterial chlorhexidine digluconate as a model active substance. After application to hands, micron-sized particles preferentially accommodate space between epidermal ridges, protected against attrition. Thanks to their small size (d < 10 µm), particles are comfortable to carry since they are not recognisable by somatosensory receptors. The performance of formulations with various amounts of chlorhexidine and cross-linker was tested and compared with selected commercial disinfectants available on the Czech market (ethanol gel and alcoholic solution with chlorhexidine) against E. coli and S. epidermidis. The real-life performance was investigated with twelve volunteers performing various activities for up to 2 h. Finally, a replica of the human index finger with accurately captured micro-topology was proposed and compared with volunteers' fingers concerning the total amount of adhered and detached particles.
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Affiliation(s)
- Lucie Večerková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Lucie Mašková
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Zdeněk Knejzlík
- Institute of Organic Chemistry and Biochemistry, Czech Academy of Sciences, Flemingovo náměstí 542/2, 160 00, Prague 6, Czech Republic
| | - Ondřej Kašpar
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic
| | - Viola Tokárová
- Department of Chemical Engineering, University of Chemistry and Technology Prague, Technická 5, 166 28, Prague 6, Czech Republic.
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Effect of Online Instruction on the Level of Knowledge About Clostridium difficile Infection Among Undergraduate Nursing Students in a Developing Country. INFECTIOUS DISEASES IN CLINICAL PRACTICE 2023. [DOI: 10.1097/ipc.0000000000001238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/19/2023]
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Comparcini D, Simonetti V, Segala FV, Di Gennaro F, Bavaro DF, Pompeo MA, Saracino A, Cicolini G. Nurses’ Knowledge, Attitudes and Practices on the Management of Clostridioides difficile Infection: A Cross-Sectional Study. Antibiotics (Basel) 2023; 12:antibiotics12030529. [PMID: 36978396 PMCID: PMC10044176 DOI: 10.3390/antibiotics12030529] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 03/02/2023] [Accepted: 03/04/2023] [Indexed: 03/09/2023] Open
Abstract
Clostridioides difficile is, worldwide, the leading cause of hospital-acquired infection. Outbreaks are largely related to antibiotic exposure and contact contamination, but little is known about C. difficle infection (CDI) awareness in the nurse population. We conducted a cross-sectional survey to study Italian nurses, based on CDI guidelines. We recruited 200 nurses working in 14 Italian hospitals. Using a one-way analysis of variance of knowledge scores, female nurses (mean 9.67 (standard deviation ± 1.63), p = 0.03), and nurses with a higher level of university education (mean 9.79 (SD ± 1.67), p = 0.04) were demonstrated to have better knowledge about CDI. In addition, 92.5% (n = 184) of the sample declared that they did not have specific postgraduate training about CDI. Seventy-four percent (n = 149) of the respondents declared that they used procedures, protocols and guidelines about CDI in their workplace, but only 46.5% (n = 93) reported using C. difficile-specific bundles during their daily practice. In conclusion, our study highlights a lack of knowledge concerning CDI clinical guidelines among Italian nurses.
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Affiliation(s)
- Dania Comparcini
- CdL Infermieristica di Ancona, Facoltà Medicina e Chirurgia, Università Politecnica delle Marche (Univpm), 60121 Ancona, Italy
| | - Valentina Simonetti
- Dipartimento di Medicina e Chirurgia, LUM “Giuseppe Degennaro”, 70121 Bari, Italy
| | - Francesco Vladimiro Segala
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
- Correspondence:
| | - Francesco Di Gennaro
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Davide Fiore Bavaro
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | | | - Annalisa Saracino
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
| | - Giancarlo Cicolini
- Department of Precision and Regenerative Medicine and Ionian Area—(DiMePRe-J), University of Bari “Aldo Moro”, 70121 Bari, Italy
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Walker J. Implementing COVID-19 infection prevention and control measures in long-term care settings. Nurs Older People 2022; 34:34-42. [PMID: 35262291 DOI: 10.7748/nop.2022.e1384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/09/2021] [Indexed: 06/14/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has had far-reaching and significant effects worldwide. Many of those identified as most vulnerable to the disease reside in long-term care settings such as nursing and residential homes, so infection prevention and control is an essential area of practice. This article describes how COVID-19 is transmitted and discusses various measures that can be taken to reduce the spread of infection to protect residents, staff and visitors. Such measures include social distancing, routine screening, the use of personal protective equipment and cleaning.
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Baquero F, Saralegui C, Marcos-Mencía D, Ballestero L, Vañó-Galván S, Moreno-Arrones ÓM, Del Campo R. Epidermis as a Platform for Bacterial Transmission. Front Immunol 2021; 12:774018. [PMID: 34925344 PMCID: PMC8671829 DOI: 10.3389/fimmu.2021.774018] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 11/03/2021] [Indexed: 11/13/2022] Open
Abstract
The epidermis constitutes a continuous external layer covering the body, offering protection against bacteria, the most abundant living organisms that come into contact with this barrier. The epidermis is heavily colonized by commensal bacterial organisms that help protect against pathogenic bacteria. The highly regulated and dynamic interaction between the epidermis and commensals involves the host’s production of nutritional factors promoting bacterial growth together to chemical and immunological bacterial inhibitors. Signal trafficking ensures the system’s homeostasis; conditions that favor colonization by pathogens frequently foster commensal growth, thereby increasing the bacterial population size and inducing the skin’s antibacterial response, eliminating the pathogens and re-establishing the normal density of commensals. The microecological conditions of the epidermis favors Gram-positive organisms and are unsuitable for long-term Gram-negative colonization. However, the epidermis acts as the most important host-to-host transmission platform for bacteria, including those that colonize human mucous membranes. Bacteria are frequently shared by relatives, partners, and coworkers. The epidermal bacterial transmission platform of healthcare workers and visitors can contaminate hospitalized patients, eventually contributing to cross-infections. Epidermal transmission occurs mostly via the hands and particularly through fingers. The three-dimensional physical structure of the epidermis, particularly the fingertips, which have frictional ridges, multiplies the possibilities for bacterial adhesion and release. Research into the biology of bacterial transmission via the hands is still in its infancy; however, tribology, the science of interacting surfaces in relative motion, including friction, wear and lubrication, will certainly be an important part of it. Experiments on finger-to-finger transmission of microorganisms have shown significant interindividual differences in the ability to transmit microorganisms, presumably due to genetics, age, sex, and the gland density, which determines the physical, chemical, adhesive, nutritional, and immunological status of the epidermal surface. These studies are needed to optimize interventions and strategies for preventing the hand transmission of microorganisms.
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Affiliation(s)
- Fernando Baquero
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Network Center for Research in Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Claudia Saralegui
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Daniel Marcos-Mencía
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Luna Ballestero
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain
| | - Sergio Vañó-Galván
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Óscar M Moreno-Arrones
- Servicio de Dermatología, Hospital Universitario Ramón y Cajal, and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Universidad de Alcalá, Madrid, Spain
| | - Rosa Del Campo
- Servicio de Microbiología, Hospital Universitario Ramón y Cajal and Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Madrid, Spain.,Department of Health Sciences, Universidad Alfonso X El Sabio, Madrid, Spain.,Centro de Investigación en Red en Enfermedades Infecciosas (CIBER-EEII), Madrid, Spain
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Balazinski M, Schmidt-Bleker A, Winter J, von Woedtke T. Peroxynitrous Acid Generated In Situ from Acidified H 2O 2 and NaNO 2. A Suitable Novel Antimicrobial Agent? Antibiotics (Basel) 2021; 10:1003. [PMID: 34439053 PMCID: PMC8388962 DOI: 10.3390/antibiotics10081003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 08/13/2021] [Accepted: 08/17/2021] [Indexed: 11/18/2022] Open
Abstract
Peroxynitrite (ONOO-) and peroxynitrous acid (ONOOH) are known as short acting reactive species with nitrating and oxidative properties, which are associated with their antimicrobial effect. However, to the best of our knowledge, ONOOH/ONOO- are not yet used as antimicrobial actives in practical applications. The aim is to elucidate if ONOOH generated in situ from acidified hydrogen peroxide (H2O2) and sodium nitrite (NaNO2) may serve as an antimicrobial active in disinfectants. Therefore, the dose-response relationship and mutagenicity are investigated. Antimicrobial efficacy was investigated by suspension tests and mutagenicity by the Ames test. Tests were conducted with E. coli. For investigating the dose-response relationship, pH values and concentrations of H2O2 and NaNO2 were varied. The antimicrobial efficacy is correlated to the dose of ONOOH, which is determined by numerical computations. The relationship can be described by the efficacy parameter W, corresponding to the amount of educts consumed during exposure time. Sufficient inactivation was observed whenever W ≥ 1 mM, yielding a criterion for inactivation of E. coli by acidified H2O2 and NaNO2. No mutagenicity of ONOOH was noticed. While further investigations are necessary, results indicate that safe and effective usage of ONOOH generated from acidified H2O2 and NaNO2 as a novel active in disinfectants is conceivable.
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Affiliation(s)
- Martina Balazinski
- Leibniz Institute for Plasma Science and Technology, Felix-Hausdorff-Straße 2, 17489 Greifswald, Germany; (A.S.-B.); (J.W.); (T.v.W.)
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Opportunities for Nanomedicine in Clostridioides difficile Infection. Antibiotics (Basel) 2021; 10:antibiotics10080948. [PMID: 34438998 PMCID: PMC8388953 DOI: 10.3390/antibiotics10080948] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 07/30/2021] [Accepted: 08/03/2021] [Indexed: 12/19/2022] Open
Abstract
Clostridioides difficile, a spore-forming bacterium, is a nosocomial infectious pathogen which can be found in animals as well. Although various antibiotics and disinfectants were developed, C. difficile infection (CDI) remains a serious health problem. C. difficile spores have complex structures and dormant characteristics that contribute to their resistance to harsh environments, successful transmission and recurrence. C. difficile spores can germinate quickly after being exposed to bile acid and co-germinant in a suitable environment. The vegetative cells produce endospores, and the mature spores are released from the hosts for dissemination of the pathogen. Therefore, concurrent elimination of C. difficile vegetative cells and inhibition of spore germination is essential for effective control of CDI. This review focused on the molecular pathogenesis of CDI and new trends in targeting both spores and vegetative cells of this pathogen, as well as the potential contribution of nanotechnologies for the effective management of CDI.
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Stethoscope hygiene: A call to action. Recommendations to update the CDC guidelines. Infect Control Hosp Epidemiol 2021; 42:740-742. [PMID: 34009112 DOI: 10.1017/ice.2021.115] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Healthcare-acquired infections are a tremendous challenge to the US medical system. Stethoscopes touch many patients, but current guidance from the Centers for Disease Control and Prevention does not support disinfection between each patient. Stethoscopes are rarely disinfected between patients by healthcare providers. When cultured, even after disinfection, stethoscopes have high rates of pathogen contamination, identical to that of unwashed hands. The consequence of these practices may bode poorly in the coronavirus 2019 disease (COVID-19) pandemic. Alternatively, the CDC recommends the use of disposable stethoscopes. However, these instruments have poor acoustic properties, and misdiagnoses have been documented. They may also serve as pathogen vectors among staff sharing them. Disposable aseptic stethoscope diaphragm barriers can provide increased safety without sacrificing stethoscope function. We recommend that the CDC consider the research regarding stethoscope hygiene and effective solutions to contemporize this guidance and elevate stethoscope hygiene to that of the hands, by requiring stethoscope disinfection or change of disposable barrier between every patient encounter.
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Abstract
Objective To evaluate whether Clostridioides (formerly Clostridium) difficile–contaminated stethoscope diaphragms remained aseptic by the placement of an aseptic diaphragm barrier. Methods On November 1, 2019, fresh cultures of C difficile were diluted to 107 colony-forming units (CFU)/mL and used to inoculate 16 stethoscope diaphragms; 8 had an aseptic diaphragm barrier applied and 8 served as nonbarrier controls. Contaminated stethoscopes were anaerobically incubated, then swabbed at 15 and 30 minutes, 2 and 4 hours, and 1, 2, 3, and 7 days after inoculation and subsequently plated onto blood, chocolate, and cycloserine-cefoxitin fructose agar. Plates were incubated for 48 hours and on November 9, 2019, the resulting colonies were manually counted. Statistical analyses (RStudio, version 1.0.153) used analysis of variance with post hoc Tukey honestly significant difference. Results Overall, mean colony count was 33 CFU on stethoscopes without barriers vs zero on those with barriers (P≤.05). Growth was greatest at 48 hours, with colony counts as high as 160 CFU. The presence of the barrier resulted in no growth in 100% of stethoscope diaphragms for up to 1 week. Conclusion We found that stethoscope diaphragm barriers provide an aseptic patient contact point, thus reducing the potential for transmission of C difficile during the physical examination. In critical care environments, in which many hospitals use acoustically inferior disposable stethoscopes, the option of a disposable aseptic stethoscope barrier may allow high-quality auscultation while reducing the potential for pathogen transmission.
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Doll M, Marra AR, Apisarnthanarak A, Al-Maani AS, Abbas S, Rosenthal VD. Prevention of Clostridioides difficile in hospitals: A position paper of the International Society for Infectious Diseases. Int J Infect Dis 2020; 102:188-195. [PMID: 33122100 DOI: 10.1016/j.ijid.2020.10.039] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Revised: 10/19/2020] [Accepted: 10/20/2020] [Indexed: 02/07/2023] Open
Abstract
Clostridioides difficile infection is an increasing presence worldwide. Prevention is multipronged, reflecting a complex and evolving epidemiology. Multiple guidelines exist regarding the prevention of C. difficile infection in healthcare settings; however, existing guidelines do not address C. difficile in low- and middle-income countries (LMIC). Nevertheless, the prevalence of C. difficile in LMIC likely parallels, if not exceeds, that of high-income countries, and LMIC may experience additional challenges in C. difficile diagnosis and control. A panel of experts was convened by the International Society for Infectious Diseases (ISID) to review the current state of C. difficile infections globally and make evidence-based recommendations for infection prevention that are broadly applicable.
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Affiliation(s)
- Michelle Doll
- Department of Internal Medicine, Virginia Commonwealth University School of Medicine, Richmond, VA, USA
| | - Alexandre R Marra
- Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, USA; Division of Medical Practice, Hospital Israelita Albert Einstein, São Paulo, Brazil
| | - Anucha Apisarnthanarak
- Division of Infectious Diseases, Faculty of Medicine, Thammasat University, Pathum Thani, Thailand
| | - Amal Saif Al-Maani
- Department of Infection Control and Prevention, Ministry of Health, Muscat, Oman
| | - Salma Abbas
- Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Center, Lahore, Pakistan
| | - Victor D Rosenthal
- International Nosocomial Infection Control Consortium (INICC), Buenos Aires, Argentina
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Prevention of Clostridium difficile Infection and Associated Diarrhea: An Unsolved Problem. Microorganisms 2020; 8:microorganisms8111640. [PMID: 33114040 PMCID: PMC7690700 DOI: 10.3390/microorganisms8111640] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2020] [Revised: 10/18/2020] [Accepted: 10/19/2020] [Indexed: 02/08/2023] Open
Abstract
For many years, it has been known that Clostridium difficile (CD) is the primary cause of health-care-associated infectious diarrhea, afflicting approximately 1% of hospitalized patients. CD may be simply carried or lead to a mild disease, but in a relevant number of patients, it can cause a very severe, potentially fatal, disease. In this narrative review, the present possibilities of CD infection (CDI) prevention will be discussed. Interventions usually recommended for infection control and prevention can be effective in reducing CDI incidence. However, in order to overcome limitations of these measures and reduce the risk of new CDI episodes, novel strategies have been developed. As most of the cases of CDI follow antibiotic use, attempts to rationalize antibiotic prescriptions have been implemented. Moreover, to reconstitute normal gut microbiota composition and suppress CD colonization in patients given antimicrobial drugs, administration of probiotics has been suggested. Finally, active and passive immunization has been studied. Vaccines containing inactivated CD toxins or components of CD spores have been studied. Passive immunization with monoclonal antibodies against CD toxins or the administration of hyperimmune whey derived from colostrum or breast milk from immunized cows has been tried. However, most advanced methods have significant limitations as they cannot prevent colonization and development of primary CDI. Only the availability of vaccines able to face these problems can allow a resolutive approach to the total burden due to this pathogen.
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Scotoni M, Koch J, Julian TR, Clack L, Pitol AK, Wolfensberger A, Grass RN, Sax H. Silica nanoparticles with encapsulated DNA (SPED) - a novel surrogate tracer for microbial transmission in healthcare. Antimicrob Resist Infect Control 2020; 9:152. [PMID: 32938493 PMCID: PMC7493369 DOI: 10.1186/s13756-020-00813-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 08/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background The increase in antimicrobial resistance is of worldwide concern. Surrogate tracers attempt to simulate microbial transmission by avoiding the infectious risks associated with live organisms. We evaluated silica nanoparticles with encapsulated DNA (SPED) as a new promising surrogate tracer in healthcare. Methods SPED and Escherichia coli were used to implement three experiments in simulation rooms and a microbiology laboratory in 2017–2018. Experiment 1 investigated the transmission behaviour of SPED in a predefined simulated patient-care scenario. SPED marked with 3 different DNA sequences (SPED1-SPED3) were introduced at 3 different points of the consecutive 13 touch sites of a patient-care scenario that was repeated 3 times, resulting in a total of 288 values. Experiment 2 evaluated SPED behaviour following hand cleaning with water and soap and alcohol-based handrub. Experiment 3 compared transfer dynamics of SPED versus E. coli in a laboratory using a gloved finger touching two consecutive sites on a laminate surface after a first purposefully contaminated site. Results Experiment 1: SPED adhesiveness on bare skin after a hand-to-surface exposure was high, leading to a dissemination of SPED1–3 on all consecutive surface materials with a trend of decreasing recovery rates, also reflecting touching patterns in concordance with contaminated fingers versus palms. Experiment 2: Hand washing with soap and water resulted in a SPED reduction of 96%, whereas hand disinfection led to dispersal of SPED from the palm to the back of the hand. Experiment 3: SPED and E. coli concentration decreased in parallel with each transmission step – with SPED showing a trend for less reduction and variability. Conclusions SPED represent a convenient and safe instrument to simulate pathogen spread by contact transmission simultaneously from an infinite number of sites. They can be further developed as a central asset for successful infection prevention in healthcare.
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Affiliation(s)
- Manuela Scotoni
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, HAL14, 8091, Zurich, Switzerland
| | - Julian Koch
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Timothy R Julian
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Lauren Clack
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, HAL14, 8091, Zurich, Switzerland
| | - Ana K Pitol
- Department of Environmental Microbiology, Eawag, Swiss Federal Institute of Aquatic Science and Technology, Duebendorf, Switzerland
| | - Aline Wolfensberger
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, HAL14, 8091, Zurich, Switzerland
| | - Robert N Grass
- Department of Chemistry and Applied Biosciences, ETH Zurich, Zurich, Switzerland
| | - Hugo Sax
- Department of Infectious Diseases and Hospital Epidemiology, University Hospital Zurich, University of Zurich, Raemistrasse 100, HAL14, 8091, Zurich, Switzerland.
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Barker AK, Scaria E, Safdar N, Alagoz O. Evaluation of the Cost-effectiveness of Infection Control Strategies to Reduce Hospital-Onset Clostridioides difficile Infection. JAMA Netw Open 2020; 3:e2012522. [PMID: 32789514 PMCID: PMC7426752 DOI: 10.1001/jamanetworkopen.2020.12522] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Accepted: 05/25/2020] [Indexed: 12/14/2022] Open
Abstract
Importance Clostridioides difficile infection is the most common hospital-acquired infection in the United States, yet few studies have evaluated the cost-effectiveness of infection control initiatives targeting C difficile. Objective To compare the cost-effectiveness of 9 C difficile single intervention strategies and 8 multi-intervention bundles. Design, Setting, and Participants This economic evaluation was conducted in a simulated 200-bed tertiary, acute care, adult hospital. The study relied on clinical outcomes from a published agent-based simulation model of C difficile transmission. The model included 4 agent types (ie, patients, nurses, physicians, and visitors). Cost and utility estimates were derived from the literature. Interventions Daily sporicidal cleaning, terminal sporicidal cleaning, health care worker hand hygiene, patient hand hygiene, visitor hand hygiene, health care worker contact precautions, visitor contact precautions, C difficile screening at admission, and reduced intrahospital patient transfers. Main Outcomes and Measures Cost-effectiveness was evaluated from the hospital perspective and defined by 2 measures: cost per hospital-onset C difficile infection averted and cost per quality-adjusted life-year (QALY). Results In this agent-based model of a simulated 200-bed tertiary, acute care, adult hospital, 5 of 9 single intervention strategies were dominant, reducing cost, increasing QALYs, and averting hospital-onset C difficile infection compared with baseline standard hospital practices. They were daily cleaning (most cost-effective, saving $358 268 and 36.8 QALYs annually), health care worker hand hygiene, patient hand hygiene, terminal cleaning, and reducing intrahospital patient transfers. Screening at admission cost $1283/QALY, while health care worker contact precautions and visitor hand hygiene interventions cost $123 264/QALY and $5 730 987/QALY, respectively. Visitor contact precautions was dominated, with increased cost and decreased QALYs. Adding screening, health care worker hand hygiene, and patient hand hygiene sequentially to the daily cleaning intervention formed 2-pronged, 3-pronged, and 4-pronged multi-intervention bundles that cost an additional $29 616/QALY, $50 196/QALY, and $146 792/QALY, respectively. Conclusions and Relevance The findings of this study suggest that institutions should seek to streamline their infection control initiatives and prioritize a smaller number of highly cost-effective interventions. Daily sporicidal cleaning was among several cost-saving strategies that could be prioritized over minimally effective, costly strategies, such as visitor contact precautions.
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Affiliation(s)
- Anna K. Barker
- Department of Internal Medicine, University of Michigan, Ann Arbor
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
| | - Elizabeth Scaria
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
- Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin–Madison
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15
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Bermejo Boixareu C, Tutor-Ureta P, Ramos Martínez A. [Updated review of Clostridium difficile infection in elderly]. Rev Esp Geriatr Gerontol 2020; 55:225-235. [PMID: 32423602 DOI: 10.1016/j.regg.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 12/10/2019] [Accepted: 12/19/2019] [Indexed: 06/11/2023]
Abstract
Clostridium difficile infection is the most common cause of health care-associated diarrhoea, and its incidence increases with age. Clinical challenges, risk of resistance to treatment, risk of recurrence, and treatment responses are different in elderly. The aim of this review is to discuss the updated epidemiology, pathophysiology, diagnosis, and therapeutic management of C. difficile infection in elderly with the available data.
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Affiliation(s)
| | - Pablo Tutor-Ureta
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
| | - Antonio Ramos Martínez
- Servicio de Medicina Interna, Hospital Universitario Puerta de Hierro, Majadahonda, Madrid, España
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16
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Cho JM, Pardi DS, Khanna S. Update on Treatment of Clostridioides difficile Infection. Mayo Clin Proc 2020; 95:758-769. [PMID: 32247350 DOI: 10.1016/j.mayocp.2019.08.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2019] [Revised: 07/30/2019] [Accepted: 08/12/2019] [Indexed: 02/06/2023]
Abstract
Clostridioides difficile infection (CDI) is the leading cause of health care-associated infections in the United States. The increasing incidence and recurrence rates of CDI together with its associated morbidity and mortality are great concerns. Newer treatment methods, such as narrow-spectrum antibiotics, monoclonal antibodies, and microbial replacement therapies, are being developed and implemented. We searched PubMed to identify published literature from 2010 to 2018 using the following keywords: Clostridium difficile, treatment, and therapy. Cited references were also used to identify relevant literature. This review focuses on the current standard of therapy and emerging therapies for CDI and summarizes the updated guidelines on treatment of CDI.
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Affiliation(s)
- Janice M Cho
- Department of Internal Medicine, Mayo Clinic, Rochester, MN
| | - Darrell S Pardi
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
| | - Sahil Khanna
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN.
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17
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Abstract
Clostridioides difficile remains a leading cause of healthcare-associated infection. Efforts at C. difficile prevention have been hampered by an increasingly complex understanding of transmission patterns and a high degree of heterogeneity among existing studies. Effective prevention of C. difficile infection requires multimodal interventions, including contact precautions, hand hygiene with soap and water, effective environmental cleaning, use of sporicidal cleaning agents, and antimicrobial stewardship. Roles for probiotics, avoidance of proton pump inhibitors, and isolation of asymptomatic carriers remain poorly defined.
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Affiliation(s)
- Nicholas A Turner
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
| | - Deverick J Anderson
- Duke University Medical Center, Department of Medicine, Division of Infectious Diseases, Durham, North Carolina.,Duke Center for Antimicrobial Stewardship and Infection Prevention, Durham, North Carolina
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18
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Abstract
Clostridioides (formerly: Clostridium) difficile infection (CDI) is a major cause of diarrhoea for inpatients as well as outpatients. Usually, CDI is healthcare-associated but the number of community-acquired infections is increasing. CDI is generally associated with changes in the normal intestinal microbiota caused by administration of antibiotics. Elderly and immunocompromised patients are at greater risk for CDI and CDI recurrence. Recently, the treatment options of CDI have undergone major changes: current recommendations speak against using metronidazole for primary CDI, fidaxomicin and bezlotoxumab have been added to the treatment armamentarium and microbial replacement therapies have emerged. Several other therapies are undergoing clinical trials. In this article, we review current treatment guidelines, present the most recent data on the options to treat CDI and glance towards future developments.KEY MESSAGESThe cornerstones for the treatment of CDI are vancomycin and fidaxomicin. Metronidazole should be used only in mild-to-moderate disease in younger patients who have no or only few risk factors for recurrence.In recurrent CDI, bezlotoxumab infusion (a monoclonal antibody against C. difficile toxin B) may be considered as an adjunctive therapeutic strategy in addition to the standard care provided to patients with several risk factors for recurrence.Faecal microbiota transplantation (FMT) should be offered to patients with frequently recurring CDI.
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Affiliation(s)
- Oksi Jarmo
- Department of Infectious Diseases, Turku University Hospital, University of Turku, Turku, Finland;
- CONTACT Oksi Jarmo Department of Infectious Diseases, Turku University Hospital, University of Turku, Turku, Finland
| | - Anttila Veli-Jukka
- Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
| | - Mattila Eero
- Department of Infectious Diseases, Helsinki University Central Hospital, Helsinki, Finland
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19
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Extraintestinal Clostridium difficile infection: Scrotal abscess. Anaerobe 2019; 61:102147. [PMID: 31902737 DOI: 10.1016/j.anaerobe.2019.102147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2019] [Revised: 12/18/2019] [Accepted: 12/24/2019] [Indexed: 11/21/2022]
Abstract
Clostridium difficile infection is one of the most common causes of healthcare-associated morbidity and mortality. ExtraintestinalC. difficile infection is extremely rare; though a variety of infections involving different organs have been reported. We report the first case of scrotal abscess due toC. difficile in an 84 year old male following left inguinal herniorrhaphy. Patient underwent surgical drainage of scrotal abscess and was successfully treated with culture directed antibiotic therapy.
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20
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McDonald LC, Gerding DN, Johnson S, Bakken JS, Carroll KC, Coffin SE, Dubberke ER, Garey KW, Gould CV, Kelly C, Loo V, Shaklee Sammons J, Sandora TJ, Wilcox MH. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2019; 66:e1-e48. [PMID: 29462280 DOI: 10.1093/cid/cix1085] [Citation(s) in RCA: 1244] [Impact Index Per Article: 248.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
A panel of experts was convened by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) to update the 2010 clinical practice guideline on Clostridium difficile infection (CDI) in adults. The update, which has incorporated recommendations for children (following the adult recommendations for epidemiology, diagnosis, and treatment), includes significant changes in the management of this infection and reflects the evolving controversy over best methods for diagnosis. Clostridium difficile remains the most important cause of healthcare-associated diarrhea and has become the most commonly identified cause of healthcare-associated infection in adults in the United States. Moreover, C. difficile has established itself as an important community pathogen. Although the prevalence of the epidemic and virulent ribotype 027 strain has declined markedly along with overall CDI rates in parts of Europe, it remains one of the most commonly identified strains in the United States where it causes a sizable minority of CDIs, especially healthcare-associated CDIs. This guideline updates recommendations regarding epidemiology, diagnosis, treatment, infection prevention, and environmental management.
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Affiliation(s)
| | | | - Stuart Johnson
- Edward Hines Jr Veterans Administration Hospital, Hines.,Loyola University Medical Center, Maywood, Illinois
| | | | - Karen C Carroll
- Johns Hopkins University School of Medicine, Baltimore, Maryl
| | | | - Erik R Dubberke
- Washington University School of Medicine, St Louis, Missouri
| | | | - Carolyn V Gould
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Ciaran Kelly
- Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts
| | - Vivian Loo
- McGill University Health Centre, McGill University, Montréal, Québec, Canada
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21
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Rohde JM, Jones K, Padron N, Olmsted RN, Chopra V, Dubberke ER. A Tiered Approach for Preventing Clostridioides difficile Infection. Ann Intern Med 2019; 171:S45-S51. [PMID: 31569223 DOI: 10.7326/m18-3444] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Affiliation(s)
- Jeffrey M Rohde
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.R., K.J.)
| | - Karen Jones
- University of Michigan Medical School, Ann Arbor, Michigan (J.M.R., K.J.)
| | - Norma Padron
- Health Research & Educational Trust, American Hospital Association, Chicago, Illinois (N.P.)
| | - Russell N Olmsted
- Integrated Clinical Services, Trinity Health, Livonia, Michigan (R.N.O.)
| | - Vineet Chopra
- University of Michigan Medical School and Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan (V.C.)
| | - Erik R Dubberke
- Washington University School of Medicine, St. Louis, Missouri (E.R.D.)
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22
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Srinivasa VR, Hariri R, Frank LR, Kingsley L, Magee E, Pokrywka M, Yassin MH. Hospital-associated Clostridium difficile infection and reservoirs within the hospital environment. Am J Infect Control 2019; 47:780-785. [PMID: 30723028 DOI: 10.1016/j.ajic.2018.12.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Revised: 12/11/2018] [Accepted: 12/12/2018] [Indexed: 11/25/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is a leading cause of hospital-associated infections. Antibiotic stewardship, environmental disinfection, and reduction of transmission via health care workers are the major modes of CDI prevention within hospitals. METHODS The aim of this study was to evaluate the role of the environment in the spread of CDI within hospital rooms. Bed tracing of positive-CDI inpatients was performed to detect the strength of association to specific rooms. Environmental cultures were conducted to identify adequacy of environmental C difficile (CD) spores. Whole-genome sequencing was performed to evaluate the degree of CD relatedness. RESULTS Bed tracing performed for 211 CDI patients showed a limited list of high-burden rooms. Environmental cultures for surfaces disinfected with a sporicidal agent were almost entirely negative, whereas the floors were positive for CDI in 15% of the studied patient rooms. Whole-genome sequencing did not detect any close genetic relatedness. CONCLUSIONS Unlike in an outbreak setting, bed tracing did not yield conclusive results of room reservoirs. The C diff Banana Broth culture was inexpensive, sensitive, and easy to incubate under aerobic conditions. Sporicidal disinfectants were effective in eliminating CD from the environment. CD spores were found on floors and hard-to-clean surfaces.
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23
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Hygienemaßnahmen bei Clostridioides difficile-Infektion (CDI). Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2019; 62:906-923. [DOI: 10.1007/s00103-019-02959-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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24
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Yoon C, Gong HS, Park JS, Seok HS, Park JW, Baek GH. Two-Layer Wound Sealing before Surgical Hand Washing for Surgeons with a Minor Cut Injury on the Hand. Surg Infect (Larchmt) 2019; 20:390-394. [PMID: 30810481 DOI: 10.1089/sur.2018.271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Background: There is a lack of evidence-based recommendations for surgical hand washing when there is a minor cut on the hand. We sought to evaluate whether two-layer wound sealing functions as a barrier to prevent the spread of micro-organisms. Methods: We randomly categorized 20 surgeons into subjects with either a right- or left-hand injury. Each subject was assumed to have a minor injury on the assigned hand and the other hand was used as a control. Subjects applied a waterproof topical dressing as a first layer, then protected the injured area with a second layer using an antimicrobial drape, and finally performed surgical hand rubbing. Subjects stamped each hand onto an agar plate. The injured hands were checked by an investigator to confirm the wounded area remained properly sealed after hand rubbing. Colonies were counted and the micro-organisms were identified after 48 hours of incubation. Results: There was no leak found from two-layer wound sealing after hand washing. Mean number of the colonies was 0.2 on the injured hand and 0.25 on the uninjured hand (p = 0.772). The micro-organisms cultured from both the injured and uninjured hands were coagulase-negative staphylococci. Conclusions: Using a model for a minor cut injury on the hand this study demonstrated that two-layer wound sealing is an effective barrier not only to prevent the spread of micro-organisms but also to protect surgeons.
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Affiliation(s)
- Chan Yoon
- 1 Department of Orthopedic Surgery, Seoul Bumin Hospital, Seoul, Korea
| | - Hyun Sik Gong
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jung Soo Park
- 3 Department of Laboratory Medicine, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyun Sik Seok
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jin Woo Park
- 2 Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Goo Hyun Baek
- 4 Department of Orthopedic Surgery, Seoul National University Hospital, Seoul, Korea
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25
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ASID/ACIPC position statement - Infection control for patients with Clostridium difficile infection in healthcare facilities. Infect Dis Health 2018; 24:32-43. [PMID: 30691583 DOI: 10.1016/j.idh.2018.10.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2018] [Revised: 10/08/2018] [Accepted: 10/08/2018] [Indexed: 01/05/2023]
Abstract
BACKGROUND In 2011, the Australasian Society for Infectious Diseases (ASID) and the Australian Infection Control Association (AICA), now known as the Australasian College of Infection Prevention and Control (ACIPC), produced a position statement on infection control requirements for preventing and controlling Clostridium difficile infection (CDI) in healthcare settings. METHODS The statement updated in 2017 to reflect new literature available .The authors reviewed the 2011 position statement and critically appraised new literature published between 2011 and 2017 and relevant current infection control guidelines to identify where new evidence had become available or best practice had changed. RESULTS The position statement was updated incorporating the new findings. A draft version of the updated position statement was circulated for consultation to members of ASID and ACIPC. The authors responded to all comments received and updated the position statement. CONCLUSIONS This updated position statement emphasizes the importance of health service organizations having evidence-based infection prevention and control programs and comprehensive antimicrobial stewardship programs, to ensure the risk of C. difficile acquisition, transmission and infection is minimised.
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26
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Abstract
Clostridioides difficile (formerly Clostridium difficile) infection is the most frequently identified health care-associated infection in the United States. C difficile has also emerged as a cause of community-associated diarrhea, resulting in increased incidence of community-associated infection. Clinical illness ranges in severity from mild diarrhea to fulminant colitis and death. Appropriate management of infection requires understanding of the various diagnostic assays and therapeutic options as well as relevant measures to infection prevention. This article provides updated recommendations regarding the prevention, diagnosis, and treatment of incident and recurrent C difficile infection.
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Affiliation(s)
- Alice Y Guh
- From the Centers for Disease Control and Prevention, Atlanta, Georgia. (A.Y.G., P.K.K.)
| | - Preeta K Kutty
- From the Centers for Disease Control and Prevention, Atlanta, Georgia. (A.Y.G., P.K.K.)
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27
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Rubin ZA, Martin EM, Allyn P. Primary Prevention of Clostridium difficile-Associated Diarrhea: Current Controversies and Future Tools. Curr Infect Dis Rep 2018; 20:32. [PMID: 29959605 DOI: 10.1007/s11908-018-0639-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
PURPOSE OF REVIEW Clostridium difficile infection (CDI) is a major cause of morbidity and mortality in hospitalized patients and rates in most places have not decreased significantly despite broad efforts by both hospitals and public health entities. This review aims to provide readers with a better understanding of the limitations of current prevention strategies. We also review potential future tools that may be available for the primary prevention of CDI in the next decade. RECENT FINDINGS Research over the last decade has expanded our appreciation of the role of asymptomatic shedding in the healthcare setting and in the community. This review demonstrates that poor quality data underlies even well-established guidance from national authorities on basic topics such as contact precautions, avoidance of alcohol-based hand hygiene products, CDI testing, supplemental cleaning modalities, and the use of bleach solutions. Additionally, we review research on novel preventative interventions such as identification of asymptomatic carriers, supplemental environmental cleaning technologies, vaccines, and the manipulation of the intestinal microbiome. While there is preliminary data that supports further research in all of these areas, the research is not yet robust enough on which to base local or national policy recommendations, though late-phase human clinical trials of CDI vaccine trials are ongoing. Over the last decade, researchers have begun to reassess the traditional infection prevention model for CDI. Data suggesting a greater role for asymptomatic shedders has increased our understanding of current vertical prevention techniques and is forcing researchers to look more at new processes and technologies to decrease disease incidence.
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Affiliation(s)
- Zachary A Rubin
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 900, Los Angeles, CA, 90095, USA.
- UCLA Clinical Epidemiology & Infection Prevention, 924 Westwood Blvd, Suite 900, Los Angeles, CA, 90095, USA.
| | - Elise M Martin
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 900, Los Angeles, CA, 90095, USA
- UCLA Clinical Epidemiology & Infection Prevention, 924 Westwood Blvd, Suite 900, Los Angeles, CA, 90095, USA
- UCLA Antibiotic Stewardship Program, Los Angeles, CA, USA
| | - Paul Allyn
- Division of Infectious Diseases, David Geffen School of Medicine at UCLA, 924 Westwood Blvd, Suite 900, Los Angeles, CA, 90095, USA
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28
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Barker AK, Alagoz O, Safdar N. Interventions to Reduce the Incidence of Hospital-Onset Clostridium difficile Infection: An Agent-Based Modeling Approach to Evaluate Clinical Effectiveness in Adult Acute Care Hospitals. Clin Infect Dis 2018; 66:1192-1203. [PMID: 29112710 PMCID: PMC5888988 DOI: 10.1093/cid/cix962] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2017] [Accepted: 10/31/2017] [Indexed: 12/18/2022] Open
Abstract
Background Despite intensified efforts to reduce hospital-onset Clostridium difficile infection (HO-CDI), its clinical and economic impacts continue to worsen. Many institutions have adopted bundled interventions that vary considerably in composition, strength of evidence, and effectiveness. Considerable gaps remain in our knowledge of intervention effectiveness and disease transmission, which hinders HO-CDI prevention. Methods We developed an agent-based model of C. difficile transmission in a 200-bed adult hospital using studies from the literature, supplemented with primary data collection. The model includes an environmental component and 4 distinct agent types: patients, visitors, nurses, and physicians. We used the model to evaluate the comparative clinical effectiveness of 9 single interventions and 8 multiple-intervention bundles at reducing HO-CDI and asymptomatic C. difficile colonization. Results Daily cleaning with sporicidal disinfectant and C. difficile screening at admission were the most effective single-intervention strategies, reducing HO-CDI by 68.9% and 35.7%, respectively (both P < .001). Combining these interventions into a 2-intervention bundle reduced HO-CDI by 82.3% and asymptomatic hospital-onset colonization by 90.6% (both, P < .001). Adding patient hand hygiene to healthcare worker hand hygiene reduced HO-CDI rates an additional 7.9%. Visitor hand hygiene and contact precaution interventions did not reduce HO-CDI, compared with baseline. Excluding those strategies, healthcare worker contact precautions were the least effective intervention at reducing hospital-onset colonization and infection. Conclusions Identifying and managing the vast hospital reservoir of asymptomatic C. difficile by screening and daily cleaning with sporicidal disinfectant are high-yield strategies. These findings provide much-needed data regarding which interventions to prioritize for optimal C. difficile control.
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Affiliation(s)
- Anna K Barker
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
| | - Oguzhan Alagoz
- Department of Population Health Sciences, School of Medicine and Public Health, Madison, Wisconsin
- Department of Industrial and Systems Engineering, College of Engineering, Madison, Wisconsin
| | - Nasia Safdar
- Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
- William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
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29
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Hall JA, Keul RR, Shanks JD, Fader R, Herrington JD. Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? Am J Infect Control 2017; 45:1279-1280. [PMID: 28596022 DOI: 10.1016/j.ajic.2017.04.284] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2017] [Revised: 04/19/2017] [Accepted: 04/20/2017] [Indexed: 10/19/2022]
Abstract
The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile. A convenience sample of 120 alcohol-based dispensers was evaluated for the presence of C difficile either by culture or polymerase chain reaction for C difficile toxin. The results demonstrated that C difficile was not cultured, and C difficile toxin was not detected using polymerase chain reaction; however, gram-positive rods, Clostridium perfringens, Pantoea agglomerans, coagulase-negative Staphylococcus, Peptostreptococcus, Bacillus spp, and microaerophilic Streptococcus were present within the overflow basins of the alcohol-based dispensers.
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Healthcare-Associated Clostridium difficile Infections are Sustained by Disease from the Community. Bull Math Biol 2017; 79:2242-2257. [PMID: 28776206 DOI: 10.1007/s11538-017-0328-8] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 07/20/2017] [Indexed: 02/08/2023]
Abstract
Clostridium difficile infections (CDIs) are some of the most common hospital-associated infections worldwide. Approximately 5% of the general population is colonised with the pathogen, but most are protected from disease by normal intestinal flora or immune responses to toxins. We developed a stochastic compartmental model of CDI in hospitals that captures the condition of the host's gut flora and the role of adaptive immune responses. A novel, derivative-based method for sensitivity analysis of individual-level outcomes was developed and applied to the model. The model reproduced the observed incidence and recurrence rates for hospitals with high and moderate incidence of hospital-acquired CDI. In both scenarios, the reproduction number for within-hospital transmission was less than 1 (0.67 and 0.44, respectively), but the proportion colonised with C. difficile at discharge (7.3 and 6.1%, respectively) exceeded the proportion colonised at admission (5%). The transmission and prevalence of CDI were most sensitive to the average length of stay and the transmission rate of the pathogen. Recurrent infections were most strongly affected by the treatment success rate and the immune profile of patients. Transmission within hospitals is substantial and leads to a net export of colonised individuals to the broader community. However, within-hospital transmission alone is insufficient to sustain endemic conditions in hospitals without the constant importation of colonised individuals. Improved hygiene practices to reduce transmission from symptomatic and asymptomatic individuals and reduced length of stay are most likely to reduce within-hospital transmission and infections; however, these interventions are likely to have a smaller effect on the probability of recurrence. Immunising inpatients against the toxins produced by C. difficile will reduce the incidence of CDI but may increase transmission.
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31
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Deschênes P, Chano F, Dionne LL, Pittet D, Longtin Y. Efficacy of the World Health Organization-recommended handwashing technique and a modified washing technique to remove Clostridium difficile from hands. Am J Infect Control 2017; 45:844-848. [PMID: 28526314 DOI: 10.1016/j.ajic.2017.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2017] [Revised: 04/02/2017] [Accepted: 04/03/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The efficacy of the World Health Organization (WHO)-recommended handwashing technique against Clostridium difficile is uncertain, and whether it could be improved remains unknown. Also, the benefit of using a structured technique instead of an unstructured technique remains unclear. METHODS This study was a prospective comparison of 3 techniques (unstructured, WHO, and a novel technique dubbed WHO shortened repeated [WHO-SR] technique) to remove C difficile. Ten participants were enrolled and performed each technique. Hands were contaminated with 3 × 106 colony forming units (CFU) of a nontoxigenic strain containing 90% spores. Efficacy was assessed using the whole-hand method. The relative efficacy of each technique and of a structured (either WHO or WHO-SR) vs an unstructured technique were assessed by Mann-Whitney U test and Wilcoxon signed-rank test. RESULTS The median effectiveness of the unstructured, WHO, and WHO-SR techniques in log10 CFU reduction was 1.30 (interquartile range [IQR], 1.27-1.43), 1.71 (IQR, 1.34-1.91), and 1.70 (IQR, 1.54-2.42), respectively. The WHO-SR technique was significantly more efficacious than the unstructured technique (P = .01). Washing hands with a structured technique was more effective than washing with an unstructured technique (median, 1.70 vs 1.30 log10 CFU reduction, respectively; P = .007). CONCLUSIONS A structured washing technique is more effective than an unstructured technique against C difficile.
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32
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Parga JJ, Valadez M, Chang RKR, Sarin-Gulian A, Holdbrooks H, Sklansky MS. Handshake-free zone in a neonatal intensive care unit: Initial feasibility study. Am J Infect Control 2017; 45:787-792. [PMID: 28320565 DOI: 10.1016/j.ajic.2017.01.021] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2016] [Revised: 01/18/2017] [Accepted: 01/18/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND The handshake represents a social custom with special importance in health care settings. However, handshakes can transmit disease and compliance with hand hygiene protocols averages <50%. We hypothesized that a handshake-free zone (HFZ) could be established within our neonatal intensive care unit (NICU) and would be well-received by patient families and their health care providers (HCPs). METHODS We established an HFZ and conducted a prospective cohort study in the NICU at 2 UCLA Medical Centers. Data collection tools included questionnaires for NICU families and their HCPs. RESULTS Handshake greetings occurred more frequently before than during the HFZ, as reported by HCPs (P = .0002) and patient families (P = .05). Before the HFZ, physicians were more likely than nurses to shake hands with patient families (P = .001), and believe the handshake was extremely important (P = .002); during the HFZ physicians' behaviors and attitudes shifted toward those of the nurses. All patient families and 66% of HCPs believed the NICU should consider establishing an HFZ. CONCLUSIONS The HFZ decreased the frequency of handshakes within the NICU. The influence of the HFZ on HCP behavior and attitudes varied with gender and profession. Patient families and most HCPs supported the implementation of an HFZ.
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Affiliation(s)
- Joanna J Parga
- UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Maria Valadez
- UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Ruey-Kang R Chang
- Department of Pediatrics, Harbor-University of California, Los Angeles, Torrance, CA
| | - Anahit Sarin-Gulian
- UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Heaven Holdbrooks
- UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA
| | - Mark S Sklansky
- UCLA Mattel Children's Hospital, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA.
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Pearls in Infection Control for Clostridium difficile Infections in Healthcare Facilities. CURRENT TREATMENT OPTIONS IN INFECTIOUS DISEASES 2017. [DOI: 10.1007/s40506-017-0114-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Barker A, Ngam C, Musuuza J, Vaughn VM, Safdar N. Reducing Clostridium difficile in the Inpatient Setting: A Systematic Review of the Adherence to and Effectiveness of C. difficile Prevention Bundles. Infect Control Hosp Epidemiol 2017; 38:639-650. [PMID: 28343455 PMCID: PMC5654380 DOI: 10.1017/ice.2017.7] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Clostridium difficile infection (CDI) is the most common infectious cause of nosocomial diarrhea, and its prevention is an urgent public health priority. However, reduction of CDI is challenging because of its complex pathogenesis, large reservoirs of colonized patients, and the persistence of infectious spores. The literature lacks high-quality evidence for evaluating interventions, and many hospitals have implemented bundled interventions to reduce CDI with variable results. Thus, we conducted a systematic review to examine the components of CDI bundles, their implementation processes, and their impact on CDI rates. METHODS We conducted a comprehensive literature search of multiple computerized databases from their date of inception through April 30, 2016. The protocol was registered in PROSPERO, an international prospective register of systematic reviews. Bundle effectiveness, adherence, and study quality were assessed for each study meeting our criteria for inclusion. RESULTS In the 26 studies that met the inclusion criteria for this review, implementation and adherence factors to interventions were variably and incompletely reported, making study reproducibility and replicability challenging. Despite contextual differences and the variety of bundle components utilized, all 26 studies reported an improvement in CDI rates. However, given the lack of randomized controlled trials in the literature, assessing a causal relationship between bundled interventions and CDI rates is currently impossible. CONCLUSION Cluster randomized trials that include a rigorous assessment of the implementation of bundled interventions are urgently needed to causally test the effect of intervention bundles on CDI rates. Infect Control Hosp Epidemiol 2017;38:639-650.
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Affiliation(s)
- Anna Barker
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Caitlyn Ngam
- Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Jackson Musuuza
- Institute of Clinical and Translational Research, University of Wisconsin, Madison, WI, USA
| | - Valerie M. Vaughn
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
- The Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Health System, Ann Arbor, MI, USA
| | - Nasia Safdar
- William S. Middleton Memorial Veterans Affairs Hospital, Madison, WI, USA
- Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
- Department of Infection Control, University of Wisconsin Hospital and Clinics, Madison, WI, USA
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Zil-E-Ali A, Cheema MA, Wajih Ullah M, Ghulam H, Tariq M. A Survey of Handwashing Knowledge and Attitudes among the Healthcare Professionals in Lahore, Pakistan. Cureus 2017; 9:e1089. [PMID: 28413735 PMCID: PMC5388362 DOI: 10.7759/cureus.1089] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the knowledge and attitudes towards handwashing of clinical year medical and dental students and health-care professionals (HCPs) working in the departments of medicine, surgery, dentistry, nursing, and physiotherapy in Lahore, Pakistan. Methodology This was a cross-sectional survey conducted during May and June 2016. After approval from the institutional review board, a modified form of the World Health Organization (WHO) Hand Hygiene Knowledge Questionnaire for Healthcare workers that included 18 items was sent to 400 clinical year students and HCPs from six medical colleges and affiliated hospitals of Lahore. The data obtained was entered and analyzed by using IBM SPSS version 20 (IBM, NY, USA). Chi-square was used as the test of significance. A p-value of <0.05 was considered statistically significant for all purposes. Results The response rate was 79%. Less than half of the respondents (149, 47.9%) were satisfied with their knowledge regarding hand hygiene. Statistically significant associations of various groups of HCPs were observed with their satisfaction regarding knowledge about hand hygiene (p-value = 0.022), their awareness of the proper technique required for handwashing proposed by the WHO (p-value = 0.001), and their awareness about other preventive techniques proposed by the WHO and Centers for Disease Control (CDC) (p-value = 0.021). Conclusions The majority of the clinical year students and HCPs were not satisfied with their knowledge regarding hand hygiene. HCPs working in different departments have varying knowledge and attitudes towards hand hygiene. Females were found to be more satisfied with their handwashing practices. Teaching proper technique of handwashing to medical students and starting refresher courses regarding hand hygiene for HCPs are dire needs. The WHO-recommended guidelines should not only be taught but also implemented in the medical field as poor hand hygiene techniques have led to the spread of many diseases around the globe.
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Affiliation(s)
- Ahsan Zil-E-Ali
- Surgery, Pakistan Institute of Medical Sciences, Islamabad, Pakistan
| | | | | | - Hamzah Ghulam
- Department of Internal Medicine & Critical Care, Fatima Memorial Hospital
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Assessing the Likelihood of Hand-to-Hand Cross-Transmission of Bacteria: An Experimental Study. Infect Control Hosp Epidemiol 2017; 38:553-558. [PMID: 28222829 DOI: 10.1017/ice.2017.9] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND Although the hands of healthcare workers (HCWs) are implicated in most episodes of healthcare-associated infections, the correlation between hand contamination and the likelihood of cross-transmission remains unknown. METHODS We conducted a laboratory-based study involving pairs of HCWs. The hands of a HCW (transmitter) were contaminated with Escherichia coli ATCC 10536 before holding hands with another HCW (host) for 1 minute. Meanwhile, the unheld hand of the transmitter was sampled. Afterward, the host's held hand was also sampled. Each experiment consisted of 4 trials with increasing concentrations of E. coli (103-106 colony-forming units [cfu]/mL). The primary outcome was the likelihood of transmission of at least 1 cfu from transmitter to host. We used a mixed logistic regression model with a random effect on the subject to assess the association between transmission and bacterial count on the transmitter's hands. RESULTS In total, 6 HCWs performed 30 experiments and 120 trials. The bacterial counts recovered from host hands were directly associated with the bacterial counts on transmitter hands (P1 and ≤3 log10 cfu compared to ≤1 log10. When transmitter contamination was <1 log10 cfu, no cross-transmission was detected. CONCLUSION There is a direct relationship between the bacterial burden on HCWs hands and the likelihood of cross-transmission. Under the described conditions, at least 1 log10 cfu must be present on HCW hands to be potentially transmitted. Further studies are needed at the low contamination range. Infect Control Hosp Epidemiol 2017;38:553-558.
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Chou PY, Doyle AJ, Arai S, Burke PJ, Bailey TR. Antibacterial Efficacy of Several Surgical Hand Preparation Products Used by Veterinary Students. Vet Surg 2016; 45:515-22. [PMID: 27120271 DOI: 10.1111/vsu.12473] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2015] [Accepted: 07/09/2015] [Indexed: 01/23/2023]
Abstract
OBJECTIVE To compare the antibacterial efficacy of different surgical hand antisepsis protocols used by veterinary students. STUDY DESIGN Prospective, randomized, controlled study. STUDY POPULATION Third year veterinary students (n=45). METHODS The participants were randomly assigned to 4 of the following 12 hand preparation product/time combinations: nonabrasive hand scrub method with 4% chlorhexidine gluconate (CH); hand rub with a mixture of 30% 1-propanol and 45% 2-propanol solution (MPS), 70% 2-propanol solution (IPS), or 61% ethanol solution with 1% chlorhexidine gluconate (ES/CH), with a contact time of 1.5, 3, or 5 minutes. Antibacterial efficacy was assessed after surgical hand preparation and at the end of surgery. Log reductions of total bacterial colony forming unit (CFU)/mL and positive aerobic culture rates were compared using multivariable analysis of variance and multivariable logistic regression, respectively. RESULTS After surgical hand preparation, CH and ES/CH provided significantly higher log CFU reduction and lower positive culture rate for Gram-positive and spore-forming bacteria compared to MPS and IPS. Increase in contact time did not provide significant improvement in bacterial reduction. At the end of surgery, ES/CH provided significantly higher log CFU reduction compared to IPS and lower positive culture rate for Gram-positive bacteria compared to CH, MPS, and IPS. Increase in contact time significantly improved log CFU reduction in ES/CH and MPS groups. CONCLUSION In our population of veterinary students ES/CH hand rubs or CH scrubs were more effective in reducing bacterial CFU during surgical hand preparation than MPS or IPS.
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Affiliation(s)
- Po-Yen Chou
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Aimie J Doyle
- Departments of Health Management, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Shiori Arai
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Pierre J Burke
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
| | - Trina R Bailey
- Departments of Companion Animal, Atlantic Veterinary Medicine, Charlottetown, Prince Edward Island, Canada
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Cooper CC, Jump RLP, Chopra T. Prevention of Infection Due to Clostridium difficile. Infect Dis Clin North Am 2016; 30:999-1012. [PMID: 27660089 DOI: 10.1016/j.idc.2016.07.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Clostridium difficile is one of the foremost nosocomial pathogens. Preventing infection is particularly challenging. Effective prevention efforts typically require a multifaceted bundled approach. A variety of infection control procedures may be advantageous, including strict hand decontamination with soap and water, contact precautions, and using chlorine-containing decontamination agents. Additionally, risk factor reduction can help reduce the burden of disease. The risk factor modification is principally accomplished though antibiotic stewardship programs. Unfortunately, most of the current evidence for prevention is in acute care settings. This review focuses on preventative approaches to reduce the incidence of Clostridium difficile infection in healthcare settings.
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Affiliation(s)
- Christopher C Cooper
- Division of Infectious Diseases, Wayne State University, 3990 John R. Street, 5 Hudson, Detroit, MI 48201, USA
| | - Robin L P Jump
- Infectious Disease Section, Medical Division, Geriatric Research Education and Clinical Center (GRECC), Louis Stokes Cleveland Veterans Affairs Medical Center, 10701 East Boulevard, Cleveland, OH 44106, USA; Division of Infectious Diseases and HIV Medicine, Department of Medicine, Case Western Reserve University, 10900 Euclid Avenue, Cleveland, OH 44106, USA
| | - Teena Chopra
- Division of Infectious Diseases, Wayne State University, 3990 John R. Street, 5 Hudson, Detroit, MI 48201, USA.
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Sasahara T, Ae R, Watanabe M, Kimura Y, Yonekawa C, Hayashi S, Morisawa Y. Contamination of healthcare workers' hands with bacterial spores. J Infect Chemother 2016; 22:521-5. [PMID: 27236515 DOI: 10.1016/j.jiac.2016.04.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2016] [Revised: 04/21/2016] [Accepted: 04/25/2016] [Indexed: 01/05/2023]
Abstract
Clostridium species and Bacillus spp. are spore-forming bacteria that cause hospital infections. The spores from these bacteria are transmitted from patient to patient via healthcare workers' hands. Although alcohol-based hand rubbing is an important hand hygiene practice, it is ineffective against bacterial spores. Therefore, healthcare workers should wash their hands with soap when they are contaminated with spores. However, the extent of health care worker hand contamination remains unclear. The aim of this study is to determine the level of bacterial spore contamination on healthcare workers' hands. The hands of 71 healthcare workers were evaluated for bacterial spore contamination. Spores attached to subject's hands were quantitatively examined after 9 working hours. The relationship between bacterial spore contamination and hand hygiene behaviors was also analyzed. Bacterial spores were detected on the hands of 54 subjects (76.1%). The mean number of spores detected was 468.3 CFU/hand (maximum: 3300 CFU/hand). Thirty-seven (52.1%) and 36 (50.7%) subjects were contaminated with Bacillus subtilis and Bacillus cereus, respectively. Nineteen subjects (26.8%) were contaminated with both Bacillus species. Clostridium difficile was detected on only one subject's hands. There was a significant negative correlation between the hand contamination level and the frequency of handwashing (r = -0.44, P < 0.01) and a significant positive correlation between the hand contamination level and the elapsed time since last handwashing (r = 0.34, P < 0.01). Healthcare workers' hands may be frequently contaminated with bacterial spores due to insufficient handwashing during daily patient care.
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Affiliation(s)
- Teppei Sasahara
- Department of Infection and Immunity, School of Medicine, Jichi Medical University, Tochigi, Japan; Center for Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan.
| | - Ryusuke Ae
- Division of Public Health, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Michiyo Watanabe
- Center for Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
| | - Yumiko Kimura
- Division of Microbiology Laboratory, Jichi Medical University Hospital, Tochigi, Japan
| | - Chikara Yonekawa
- Department of Emergency Medicine, School of Medicine, Jichi Medical University, Tochigi, Japan
| | - Shunji Hayashi
- Division of Microbiology, School of Medicine, Kitasato University, Kanagawa, Japan
| | - Yuji Morisawa
- Center for Infectious Diseases, Jichi Medical University Hospital, Tochigi, Japan
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Deyneko A, Cordeiro F, Berlin L, Ben-David D, Perna S, Longtin Y. Impact of sink location on hand hygiene compliance after care of patients with Clostridium difficile infection: a cross-sectional study. BMC Infect Dis 2016; 16:203. [PMID: 27184488 PMCID: PMC4867524 DOI: 10.1186/s12879-016-1535-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 05/04/2016] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND The impact of sink location on hand washing compliance after contact with patients with Clostridium difficile infection (CDI) is poorly understood. The aim of this study is to determine the location of hand wash sinks available to healthcare workers (HCWs) after caring for patients with CDI and to assess the impact on hand washing compliance. METHODS We performed a cross-sectional study in a 637-bed tertiary care hospital, Canada. HCW hand hygiene compliance after contact with CDI patients was measured through direct unobtrusive observations. Location of sinks in relation with the patients' rooms was assessed on the day of diagnosis. Predictors of compliance were assessed through univariate and multivariate logistic regression. RESULTS 247 hand hygiene opportunities following care of a CDI patient were observed. Glove use compliance was 85.4 % (211/247), but hand washing compliance after care of CDI patients was only 14.2 % (35/247). Hand rubbing was performed instead of hand washing in 33.2 % of opportunities (82/247). The median distance between the patient zone of CDI patients and the nearest sink was 13.1 m (interquartile range, 7.6-23.2). Sinks were directly visible upon exiting the patient's room on only 33.2 % (82/247) occasions. By multivariate analysis, an increasing distance between the patient zone and the nearest sink was inversely associated with hand washing compliance (adjusted OR, 0.90, 95 % CI, 0.84-0.97; P = 0.008), while proper timing of glove removal upon leaving the patient zone was directly associated with hand washing compliance (adjusted OR, 14.87; 95 % CI, 1.93-114.43; P = 0.01). CONCLUSIONS Hand washing compliance following contact with patients with C. difficile infections was low. Poor access to sinks is associated with decreased hand washing compliance. Improvement strategies are urgently needed.
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Affiliation(s)
- Alexander Deyneko
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Fernanda Cordeiro
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Laurie Berlin
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Debby Ben-David
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada.,Chaim Sheba Medical Center, Tel Hashomer, Israel
| | - Silvana Perna
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada
| | - Yves Longtin
- Infection Prevention and Control Unit, Jewish General Hospital - SMBD, 3755 Côte-Sainte-Catherine Road, Room E-0057, Montreal, QC, H3T 1E2, Canada. .,McGill University Faculty of Medicine, Montreal, Canada.
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Kundrapu S, Sunkesula V, Jury I, Deshpande A, Donskey CJ. A Randomized Trial of Soap and Water Hand Wash Versus Alcohol Hand Rub for Removal of Clostridium difficile Spores from Hands of Patients. Infect Control Hosp Epidemiol 2016; 35:204-6. [DOI: 10.1086/674859] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
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Strategies to Prevent Healthcare-Associated Infections through Hand Hygiene. Infect Control Hosp Epidemiol 2016; 35 Suppl 2:S155-78. [DOI: 10.1017/s0899823x00193900] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Effects of a predictive preventive model for prevention of Clostridium difficile infection in patients in intensive care units. Am J Infect Control 2016; 44:421-4. [PMID: 26775936 DOI: 10.1016/j.ajic.2015.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2015] [Revised: 11/02/2015] [Accepted: 11/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND Health care-acquired Clostridium difficile infection (HACDI) is associated with adverse outcomes at both the organization and patient level. Factors that increase risk for development of HACDI have been identified. Objectives of this study were to develop a predictive screening tool to identify patients at risk for HACDI and implement a bundle of mitigation interventions. METHODS A predictive screening tool was developed based on risk factors identified in the literature and validated by retrospective analysis of all HACDI cases occurring in critically ill patients during 2013. The tool was used to screen all patients admitted to an intensive care unit. Evidence-based interventions (bundle) were implemented for patients identified as being at high risk for HACDI. Effectiveness of the model was measured by reduction of HACDI rate during the intervention period compared with the preintervention period. RESULTS During the 12-month intervention period 217 high-risk patients were identified as infected with Clostridium difficile. Sixty-two of these met exclusion criteria, resulting in a study population of 157 patients. During the preintervention phase, 10 cases of HACDI occurred (overall incidence rate, 14.7). During the 12-month study period, 2 cases of HACDI were identified (incidence rate, 3.12). The reduction was statistically significant. CONCLUSION A strategy for identifying patients at increased risk and implementation of multidisciplinary risk-mitigation strategies is effective in reducing incidence of HACDI.
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Abstract
Purpose of review Hand hygiene and isolation are basic, but very effective, means of preventing the spread of pathogens in healthcare. Although the principle may be straightforward, this review highlights some of the controversies regarding the implementation and efficacy of these interventions. Recent findings Hand hygiene compliance is an accepted measure of quality and safety in many countries. The evidence for the efficacy of hand hygiene in directly reducing rates of hospital-acquired infections has strengthened in recent years, particularly in terms of reduced rates of staphylococcal sepsis. Defining the key components of effective implementation strategies and the ideal method(s) of assessing hand hygiene compliance are dependent on a range of factors associated with the healthcare system. Although patient isolation continues to be an important strategy, particularly in outbreaks, it also has some limitations and can be associated with negative effects. Recent detailed molecular epidemiology studies of key healthcare-acquired pathogens have questioned the true efficacy of isolation, alone as an effective method for the routine prevention of disease transmission. Summary Hand hygiene and isolation are key components of basic infection control. Recent insights into the benefits, limitations and even adverse effects of these interventions are important for their optimal implementation.
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Shields K, Araujo-Castillo RV, Theethira TG, Alonso CD, Kelly CP. Recurrent Clostridium difficile infection: From colonization to cure. Anaerobe 2015; 34:59-73. [PMID: 25930686 PMCID: PMC4492812 DOI: 10.1016/j.anaerobe.2015.04.012] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 04/22/2015] [Accepted: 04/23/2015] [Indexed: 12/16/2022]
Abstract
Clostridium difficile infection (CDI) is increasingly prevalent, dangerous and challenging to prevent and manage. Despite intense national and international attention the incidence of primary and of recurrent CDI (PCDI and RCDI, respectively) have risen rapidly throughout the past decade. Of major concern is the increase in cases of RCDI resulting in substantial morbidity, morality and economic burden. RCDI management remains challenging as there is no uniformly effective therapy, no firm consensus on optimal treatment, and reliable data regarding RCDI-specific treatment options is scant. Novel therapeutic strategies are critically needed to rapidly, accurately, and effectively identify and treat patients with, or at-risk for, RCDI. In this review we consider the factors implicated in the epidemiology, pathogenesis and clinical presentation of RCDI, evaluate current management options for RCDI and explore novel and emerging therapies.
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Affiliation(s)
- Kelsey Shields
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, United States.
| | - Roger V Araujo-Castillo
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Lowry Medical Office Building, Suite GB 110 Francis Street, Boston, MA 02215, United States.
| | - Thimmaiah G Theethira
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, United States.
| | - Carolyn D Alonso
- Division of Infectious Diseases, Beth Israel Deaconess Medical Center, Harvard Medical School, Lowry Medical Office Building, Suite GB 110 Francis Street, Boston, MA 02215, United States.
| | - Ciaran P Kelly
- Division of Gastroenterology, Beth Israel Deaconess Medical Center, Harvard Medical School, 330 Brookline Ave., Boston, MA 02215, United States.
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Ellingson K, Haas JP, Aiello AE, Kusek L, Maragakis LL, Olmsted RN, Perencevich E, Polgreen PM, Schweizer ML, Trexler P, VanAmringe M, Yokoe DS. Strategies to prevent healthcare-associated infections through hand hygiene. Infect Control Hosp Epidemiol 2015; 35:937-60. [PMID: 25026608 DOI: 10.1086/677145] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
Previously published guidelines provide comprehensive recommendations for hand hygiene in healthcare facilities. The intent of this document is to highlight practical recommendations in a concise format, update recommendations with the most current scientific evidence, and elucidate topics that warrant clarification or more robust research. Additionally, this document is designed to assist healthcare facilities in implementing hand hygiene adherence improvement programs, including efforts to optimize hand hygiene product use, monitor and report back hand hygiene adherence data, and promote behavior change. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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Isaacson D, Haller B, Leslie H, Roemer M, Winston L. Novel handwashes are superior to soap and water in removal of Clostridium difficile spores from the hands. Am J Infect Control 2015; 43:530-2. [PMID: 25952050 DOI: 10.1016/j.ajic.2015.02.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2014] [Revised: 01/31/2015] [Accepted: 02/02/2015] [Indexed: 11/27/2022]
Abstract
We examined the efficacy of 5 experimental handwash formulations in removing nontoxigenic Clostridium difficile spores from the hands of health care workers. Handwashing with sand resulted in an additional 0.5-log reduction in spore recovery compared with the current standard of soap and water.
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Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2015; 35 Suppl 2:S48-65. [PMID: 25376069 DOI: 10.1017/s0899823x00193857] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections (HAIs). The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. This document updates “Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals,” published in 2008. This expert guidance document is sponsored by the Society for Healthcare Epidemiology of America (SHEA) and is the product of a collaborative effort led by SHEA, the Infectious Diseases Society of America (IDSA), the American Hospital Association (AHA), the Association for Professionals in Infection Control and Epidemiology (APIC), and The Joint Commission, with major contributions from representatives of a number of organizations and societies with content expertise. The list of endorsing and supporting organizations is presented in the introduction to the 2014 updates.
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