Highlights
- •Time spent on training may reflect attitude to follow adopted protocols.
- •Training is the most important factor to support new practices.
- •It takes some time before hospital staff could apply protocols in a correct way.
- •Length of hospitalization is a risk factor for development of Clostridium difficile–associated disease.
Background
Clostridium difficile–associated disease (CDAD) is the most common infectious antibiotic-associated diarrhea
and is a growing health care problem. Prevention of Clostridium difficile infection focuses on clinical and epidemiologic infection control measures.
Methods
Between 2008 and 2009, we conducted a retrospective study that showed an incidence
of CDAD among the highest reported in the literature. Subsequently, we developed a
preventive protocol that was adopted in our hospital in 2010. We then conducted a
prospective study to investigate prevalence, incidence, and mortality of CDAD and
to compare the results with those of the retrospective study, evaluating adherence
to preventive measures and their efficacy.
Results
In both studies, prevalence and incidence significantly increased in older patients.
Crude prevalence was similar in the 2 studies. The incidence rate increased by 36%,
with a significant increase only in the C and D wards. In-hospital mortality rose
in both prevalent and incident cases. Regarding adhesion to hospital protocol, 77%
of prevalent cases were treated with the required procedure. The highest percentage
of isolated patients was achieved in C and D wards. In these wards we detected lower
training hours per nurse. However, in 2013, we observed a significant decrease in
incidence of CDAD and found a hospital prevalence of 0.33%.
Conclusions
Health care personnel education could be more important than the possibility of isolating
infected patients in single rooms.
Key Words
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References
- Diagnosis of Clostridium difficile infection: an ongoing conundrum for clinicians and for clinical laboratories.Clin Microbiol Rev. 2013; 26: 604
- Global epidemiology of Clostridium difficile infection in 2010.Infect Control Hosp Epidemiol. 2010; 31: S32-4
- Clostridium difficile typing methods: challenges for standardization.J Clin Microbiol. 2013; 51: 2810-2814
- Measures to control and prevent Clostridium difficile infection.Clin Infect Dis. 2008; 46: S43-9
- Strategy to prevent Clostridiun difficile infections in acute care hospital: 2014 update.Infect Control Hosp Epidemiol. 2014; 35: 628-645
- Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA).Infect Control Hosp Epidemiol. 2010; 31: 431-455
- Effectiveness of early diagnosis, prevention, and treatment of Clostridium difficile infection.Agency for Healthcare Research and Quality, US Department of Health and Human Services, Rockville (MD)2011
- Vital signs: preventing Clostridium difficile infections.MMWR Morb Mortal Wkly Rep. 2012; 61: 157-162
- Epidemiology of Clostridium difficile-associated disease in internal medicine wards in northern Italy.Intern Emerg Med. 2013; 8: 717-723
- Fondazione IRCCS Ca‘ Granda OMP.(documento del sistema qualità) P.15.F; Milan, Italy2010
- Clostridium difficile infection: how to deal with the problem.(Available from:) (Accessed June 10, 2016)
- Analysis of different incidence levels of nosocomial acquired Clostridium difficile infection in an Italian research and teaching hospital.Ann Ig. 2013; 25: 119-124
- Deliberazione n.XI/000937.(Determinazioni in ordine alla gestione del Servizio Socio Sanitario Regionale per l'esercizio)2011
- The human factor: the critical importance of effective teamwork and communication in providing safe care.Qual Saf Health Care. 2004; 13: 85-90
Article info
Publication history
Published online: June 29, 2016
Footnotes
Conflicts of Interest: None to report.
Author Contributions: S.C. and G.F. contributed to the concept and rationale for the study. G.D. and S.S. wrote the manuscript. G.D., S.S., M.M., and S.F. were involved in clinical and epidemiologic data collection. A.M. and F.S. performed microbiologic analysis. D.C. contributed to data analysis. M.L. and M.D.C. contributed to interpretation of the results. All authors participated in drafting and approval of the final manuscript and take responsibility for content and interpretation of this article.
Additional Information: No ethical approval is required for this study according to national law number 196 of the year 2003 and the regional law of the Lombardia Region number 3 of the year 2012.
Identification
Copyright
© 2016 Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved.
