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Reducing C. difficile in children: An agent-based modeling approach to evaluate intervention effectiveness

Published online by Cambridge University Press:  13 February 2020

Anna K. Barker Open the ORCID record for Anna K. Barker [Opens in a new window] ,
Elizabeth Scaria ,
Oguzhan Alagoz ,
Ajay K. Sethi  and
Nasia Safdar
Anna K. Barker*
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Elizabeth Scaria
Affiliation:
Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
Oguzhan Alagoz
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
Ajay K. Sethi
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Nasia Safdar
Affiliation:
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
*
Author for correspondence: Anna K. Barker, Email: [email protected]
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Abstract

Objective:

Clostridioides difficile infection (CDI) is rapidly increasing in children’s hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization.

Design:

Agent-based simulation model of C. difficile transmission.

Setting:

Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each.

Participants:

The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians.

Interventions:

Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions.

Results:

The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure.

Conclusions:

Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 522 - 530
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION. An abstract of this study was presented as a poster at IDWeek 2018 on October 4, 2018, in San Francisco, California, and was included with the published conference proceedings: Barker, A, Scaria E, Alagoz, O, Sethi, A, Safdar, N. Clostridium difficile reduction: an agent-based simulation modeling approach to evaluating intervention comparative effectiveness at pediatric hospitals. Open Forum Infect Dis 2018;5:S197–S198.

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