Hostname: page-component-586b7cd67f-tf8b9 Total loading time: 0 Render date: 2024-11-30T20:09:32.689Z Has data issue: false hasContentIssue false
  • English
  • Français

Reducing Clostridium difficile in the Inpatient Setting: A Systematic Review of the Adherence to and Effectiveness of C. difficile Prevention Bundles

Published online by Cambridge University Press:  27 March 2017

Anna K. Barker ,
Caitlyn Ngam ,
Jackson S. Musuuza ,
Valerie M. Vaughn  and
Nasia Safdar
Anna K. Barker
Affiliation:
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Caitlyn Ngam
Affiliation:
Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
Jackson S. Musuuza
Affiliation:
William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin
Valerie M. Vaughn
Affiliation:
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan The Patient Safety Enhancement Program, University of Michigan and VA Ann Arbor Health System, Ann Arbor, Michigan
Nasia Safdar*
Affiliation:
William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin Division of Infectious Diseases, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin Department of Infection Control, University of Wisconsin Hospital and Clinics, Madison, Wisconsin
*
Address correspondence to Nasia Safdar, MD, PhD, UWMF Centennial Building, 1685 Highland Avenue, Madison, WI 53705 ([email protected]).
Get access Rights & Permissions [Opens in a new window]

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

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 6 , June 2017 , pp. 639 - 650
Copyright
© 2017 by The Society for Healthcare Epidemiology of America. All rights reserved 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

a

Authors of equal contribution.

References

REFERENCES

1. Redelings, MD, Sorvillo, F, Mascola, L. Increase in Clostridium difficile–related Mortality Rates, United States, 1999–2004. Emerg Infect Dis 2007;13:417–419.CrossRefGoogle ScholarPubMed
2. Kuijper, EJ, van Dissel, JT, Wilcox, MH. Clostridium difficile: changing epidemiology and new treatment options. Curr Opin Infect Dis 2007;20:376–383.CrossRefGoogle ScholarPubMed
3. Freeman, J BM, Baines, SD, Corver, J, et al. The changing epidemiology of Clostridium difficile infections. Clin Microbiol Rev 2010;23:529–549.CrossRefGoogle ScholarPubMed
4. Deneve, C, Janoir, C, Poilane, I, Fantinato, C, Collignon, A. New trends in Clostridium difficile virulence and pathogenesis. Int J Antimicrob Agents 2009;33:S24–S28.CrossRefGoogle ScholarPubMed
5. Lessa, FC, Yi, M, Bamberg, WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med 2015;372:825–834.CrossRefGoogle ScholarPubMed
6. Gabriel, L, Beriot-Mathiot, A. Hospitalization stay and costs attributable to Clostridium difficile infection a critical review. J Hosp Infect 2014;88:12–21.CrossRefGoogle ScholarPubMed
7. Inclusion criteria for reporting C. difficile infection to the surveillance system. Health Protection Agency of the United Kingdom website. https://www.gov.uk/government/uploads/system/uploads/attachment_data/file/328334/c_difficile_inclusion_criteria_for_reporting.pdf. Published 2014. Accessed April 4, 2016.Google Scholar
8. Antibiotic Resistance Threats in the United States. Centers for Disease Control and Prevention website. http://www.cdc.gov/drugresistance/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed November 12, 2015.Google Scholar
9. CMS to improve quality of care during hospital inpatient stays. Centers for Medicare & Medicaid Services website. https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2014-fact-sheets-items/2014-08-04-2.html. Published 2014. Accessed April 2, 2016.Google Scholar
10. Hedge, DD, Strain, JD, Heins, JR, Farver, DK. New advances in the treatment of Clostridium difficile infection (CDI). Ther Clin Risk Manag 2008;4:949–964.Google ScholarPubMed
11. Eyre, DW, Cule, ML, Wilson, DJ, et al. Diverse sources of C. difficile infection identified on whole-genome sequencing. NEJM 2013;369:1195–1205.CrossRefGoogle ScholarPubMed
12. Walker, AS, Eyre, D, Wyllie, DH, et al. Characterization of Clostridium difficile hospital ward-based transmission using extensive epidemiological data and moleculat typing. PLOS Med. 2012;9:e1001172.CrossRefGoogle Scholar
13. Kramer, A SI, Kampf, G. How long do nosocomial pathogens persist on inanimate surfaces? A systematic review. BMC Infect Dis 2006;6:30.CrossRefGoogle Scholar
14. Kundrapu, S, Venkata, S, 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 2014;35:204–206.CrossRefGoogle ScholarPubMed
15. Jernigan, JA, Siegman-Igra, Y, Guerrant, RC, Farr, BM. A randomized crossover study of disposable thermometers for prevention of Clostridium difficile and other nosocomial infections. Infect Control Hosp Epdemiol 1998;19:494–499.CrossRefGoogle ScholarPubMed
16. Noto, MJ, Domenico, HJ, Byrne, DW, et al. Chlorhexidine bathing and health care-associated infections. JAMA 2015;313:369–378.CrossRefGoogle ScholarPubMed
17. Kundraphu, S, Sunkelsula, V, Jury, LA, Sitzlar, BM, Donskey, CJ. Daily disinfection of high-touch surfaces in isolation rooms to reduce contamination of healthcare workers’ hands. Infect Control Hosp Epidemiol 2012;33:1039–1042.CrossRefGoogle Scholar
18. Barbut, F, Menuet, D, Verachten, M, Girou, E. Comparison of the efficacy of a hydrogen peroxide dry-mist disinfection system and sodium hypochlorite solution for eradication of Clostridium difficile spores. Infect Control Hosp Epidemiol 2009;30:507–514.CrossRefGoogle ScholarPubMed
19. Furuya, EY, Dick, A, Perencevich, EN, Pogorzelska, M, Goldmann, D, Stone, PW. Central line bundle implementation in US intensive care units and impact on bloodstream infections. PLoS One 2011;6:e15452.CrossRefGoogle ScholarPubMed
20. Moher, D, Liberati, A, Tetzlaff, J, Altman, DG, the PRISMA Group. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Ann Intern Med 2009;151:264–269.CrossRefGoogle ScholarPubMed
21. Dane, AV, Schneider, B. Program integrity in primary and early secondary prevention: are implementation effects out of control? Clin Psychol Rev 1998;18:23–45.CrossRefGoogle ScholarPubMed
22. Hoffmann, T, Glasziou, PP, Boutron, I, et al. Better reporting of interventions: template for intervention description and replication (TIDieR) checklist and guide. BMJ 2014;348:g1687.CrossRefGoogle ScholarPubMed
23. Downs, SH, Black, N. The feasibility of creating a checklist for the assessment of the methodological quality both of randomised and non-randomised studies of health care interventions. J Epidemiol Commun Health 1998;52:377–384.CrossRefGoogle ScholarPubMed
24. O’Connor, SR, Tully, MA, Ryan, B, Bradley, JM, Baxter, GD, McDonough, SM. Failure of numerical quality assessment scale to identify potential risk of bias in a systematic review: a comparison study. BMC Res Notes 2015;8:224.CrossRefGoogle Scholar
25. Gulihar, A, Nixon, M, Jenkins, D, Taylor, GJ. Clostridium difficile in hip fracture patients: prevention, treatment and associated mortality. Injury 2009;40:746–751.CrossRefGoogle ScholarPubMed
26. Marufu, O, Desai, N, Aldred, D, Brown, T, Eltringham, I. Analysis of interventions to reduce the incidence of Clostridium difficile infection at a London teaching hospital trust, 2003–2011. J Hosp Infect 2015;89:38–45.CrossRefGoogle Scholar
27. Mattner, F, Winterfeld, I, Oswald, B, Solbach, W. Successful bundle of prevention measures against a high CDAD incidence at a university hospital. Hyg Med 2008;33:346–352.Google Scholar
28. Oleastro, M, Coelho, M, Giao, M, et al. Outbreak of Clostridium difficile PCR ribotype 027—the recent experience of a regional hospital. BMC Infect Dis 2014;14:209.CrossRefGoogle ScholarPubMed
29. Power, M, Wigglesworth, N, Donaldson, E, Chadwick, P, Gillibrand, S, Goldmann, D. Reducing Clostridium difficile infection in acute care by using an improvement collaborative. BMJ 2010;341:c3359.CrossRefGoogle ScholarPubMed
30. Price, J, Cheek, E, Lippett, S, et al. Impact of an intervention to control Clostridium difficile infection on hospital- and community-onset disease; an interrupted time series analysis. Clin Microbiol Infect 2010;16:1297–1302.CrossRefGoogle ScholarPubMed
31. Stone, SP, Beric, V, Quick, A, Balestrini, AA, Kibbler, CC. The effect of an enhanced infection-control policy on the incidence of Clostridium difficile infection and methicillin-resistant Staphyloccocus aureus colonization in acute elderly medical patients. Age Ageing 1998;27:561–568.CrossRefGoogle ScholarPubMed
32. Struelens, MJ, Maas, A, Nonhoff, C, et al. Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance. Am J Med 1991;91:138S–144S.CrossRefGoogle ScholarPubMed
33. White, H, Wiselka, M, Bell, D. A multi-faceted approach of one teaching hospital NHS trust during the Clostridium difficile epidemic-antibiotic management and beyond. Antibiotics Basel 2016;5:E13.CrossRefGoogle Scholar
34. Cheng, VC, Chau, P, So, SY, et al. Containment of Clostridium difficile infection without reduction in antimicrobial use in Hong Kong. Eur J Clin Microbiol Infect Dis 2015;34:1381–1386.CrossRefGoogle ScholarPubMed
35. Suzuki, H, Senda, J, Yamashita, K, et al. Impact of intensive infection control team activities on the acquisition of methicillin-resistant Staphylococcus aureus, drug-resistant Pseudomonas aeruginosa and the incidence of Clostridium difficile-associated disease. J Infect Chemother 2013;19:1047–1052.CrossRefGoogle ScholarPubMed
36. You, E, Song, H, Cho, J, Lee, J. Reduction in the incidence of hospital-acquired Clostridium difficile infection through infection control interventions other than the restriction of antimicrobial use. Int J Infect Dis 2014;22:9–10.CrossRefGoogle Scholar
37. Valiquette, L, Cossette, B, Garant, MP, Diab, H, Pepin, J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007;45:S112–S121.CrossRefGoogle ScholarPubMed
38. Muto, CA, Blank, M, Marsh, JW, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis 2007;45:1266–1273.CrossRefGoogle Scholar
39. Weiss, K, Boisvet, A, Chagnon, M, et al. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol 2009;30:156–162.CrossRefGoogle ScholarPubMed
40. Abbett, SK, Yokoe, D, Lipsitz, SR, et al. Proposed checklist of hospital interventions to decrease the incidence of healthcare-associated Clostridium difficile infection. Infect Control Hosp Epidemiol 2009;30:1062–1069.CrossRefGoogle ScholarPubMed
41. Hanna, H, Raad, I, Gonzalez, V, et al. Control of nosocomial Clostridium difficile transmission in bone marrow transplant patients. Infect Control Hosp Epidemiol 2000;21:226–228.CrossRefGoogle ScholarPubMed
42. Whitaker, J, Brown, B, Vidal, S, Calcaterra, M. Designing a protocol that eliminates Clostridium difficile: a collaborative venture. Am J Infect Control 2007;35:310–314.CrossRefGoogle ScholarPubMed
43. Wong-McClure, RA, Ramirez-Salas, E, Mora-Brenes, N, et al. Long-term effect of infection control practices and associated factors during a major Clostridium difficile outbreak in Costa Rica. J Infect Dev Ctries 2013;7:914–921.CrossRefGoogle Scholar
44. Mermel, LA, Jefferson, J, Blanchard, K, et al. Reducing Clostridium difficile incidence, colectomies, and mortality in the hospital setting: a successful multidisciplinary approach. Jt Comm J Qual Patient Saf 2013;39:298–305.Google ScholarPubMed
45. Zafar, AB, Gaydos, LA, Furlong, WB, Nguyen, MH, Mennonna, PA. Effectiveness of infection control program in controlling nosocomial Clostridium difficile . Am J Infect Control 1998;26:588–593.CrossRefGoogle ScholarPubMed
46. Salgado, CD, Mauldin, PD, Fogle, PJ, Bosso, JA. Analysis of an outbreak of Clostridium difficile infection controlled with enhanced infection control measures. Am J Infect Control 2009;37:458–464.CrossRefGoogle ScholarPubMed
47. Lai, KK, Melvin, ZS, Menard, MJ, Kotilainen, HR, Baker, S. Clostridium difficile-associated diarrheal epidemiology, risk factors, and infection control. Infect Control Hosp Epidemiol 1997;18:628–632.CrossRefGoogle Scholar
48. Apisarnthanarak, A, Zack, JE, Mayfield, JL, et al. Effectiveness of environmental nad infection control programs to reduce transmission of Clostridium difficile . Clin Infect Dis 2004;39:601–602.CrossRefGoogle Scholar
49. Bishop, J, Parry, MF, Hall, T. Decreasing Clostridium difficile infections in surgery: impact of a practice bundle incorporating a resident rounding protocol. Conn Med 2013;77:69–75.Google Scholar
50. Brakovich, B, Bonham, E, van Brackle, L. War on the spore: Clostridium difficile disease among patients in a long-term acute care hospital. J Healthc Qual 2013;35:15–21.CrossRefGoogle Scholar
51. Dubberke, E, Carling, P, Carrico, R, et al. Strategies to prevent Clostridium difficile infections in acute care hospitals: 2014 update. Infect Control Hosp Epidemiol 2014;35:628–645.CrossRefGoogle ScholarPubMed
52. Yakob, L, Riley, TV, Paterson, DL, Marquess, J, Clements, AC. Assessing control bundles for Clostridium difficile: a review and mathematical model. Emerg Microbes Infect 2014;3:e43.CrossRefGoogle ScholarPubMed
53. Koll, BS, Ruiz, R, Calfee, DP, et al. Prevention of hospital-onset Clostridium difficile infection in the New York Metropolitan Region using a collaborative intervention model. J Health Qual 2014;36:35–45.CrossRefGoogle ScholarPubMed
54. Kamboj, M, Sheahan, A, Sun, J, et al. Transmission of Clostridium difficile during hospitalization for allogeneic stem cell transplant. Infect Control Hosp Epidemiol 2016;37:8–15.CrossRefGoogle ScholarPubMed
55. Roth, VR. The more we learn, the less we know. Infect Control Hosp Epidemiol 2016;37:16–18.CrossRefGoogle ScholarPubMed
56. Gerding, D, Johnson, S, Peterson, L, Mulligan, M, Silva, J. Clostridium difficile–associated diarrhea and colitis. Infect Control Hosp Epidemiol 1995;16:459–477.CrossRefGoogle ScholarPubMed
57. Larson EL and 1992, 1993, and 1994 APIC Guidelines Committee. APIC guideline for handwashing and hand antisepsis in health care settings. Am J Infect Control 1995;23:251–269.CrossRefGoogle Scholar
58. WHO guidelines on hand hygiene in health care: first global patient safety challenge, clean care is safer care. World Health Organization website. http://www.who.int/gpsc/5may/tools/9789241597906/en/. Published 2009. Accessed March 12, 2016.Google Scholar
59. Cohen, SH, Gerding, D, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the Society for Healthcare Epidemiology of America (SHEA) and the Infections Diseases Society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
60. Jabbar, U, Leischner, J, Kasper, D, et al. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol 2010;31:565–570.CrossRefGoogle ScholarPubMed
61. Gerding, DN, Muto, C, Owens, RC. Measures to control and prevent Clostridium difficile infection. Clin Infect Dis 2008;46:S43–S49.CrossRefGoogle ScholarPubMed
Supplementary material: File

Barker supplementary material

Figure S1

Download Barker supplementary material(File)
File 33.5 KB
Supplementary material: File

Barker supplementary material

Figure S2

Download Barker supplementary material(File)
File 94.2 KB