Clinical and Healthcare Burden of Multiple Recurrences of Clostridium difficile Infection

Sheitoyan-Pesanta, C. et al. Clinical Infectious Diseases. Volume 62(5) pp. 574-580.

B0003412 Clostridium on gut lining - coloured
Image source: Med. Mic. Sciences Cardiff University – Wellcome images

Image shows colour-enhanced scanning electron micrograph of rod-shaped Clostridium difficile clinging to the microvilli of the human gut.

Background: Clostridium difficile infection (CDI) is associated with a high risk of recurrence (rCDI). Few studies have focused on multiple recurrences. To evaluate the potential of novel treatments targeting recurrence, we assessed the burden and severity of rCDI.

Methods: This was a retrospective cohort of adults diagnosed with CDI in a hospital in Sherbrooke, Canada (1998–2013). An rCDI episode was defined by the reappearance of diarrhea leading to a treatment, with or without a positive toxin assay, within 14–60 days after the previous episode.

Results: We included 1527 patients. The probability of developing a first rCDI was 25% (354/1418); a second, 38% (128/334); a third, 29% (35/121); and a fourth or more, 27% (9/33). Two or more rCDIs were observed in 9% (128/1389) of patients. The risk of a first recurrence fluctuated over time, but there was no such variation for second or further recurrences. The proportion of severe cases decreased (47% for initial episodes, 31% for first recurrences, 25% for second, 17% for third), as did the risk of complicated CDI (5.8% to 2.8%). The severity and risk of complications of first recurrences decreased over time, while oral vancomycin was used more systemically. A hospital admission was needed for 34% (148/434) of recurrences.

Conclusions: This study documented the clinical and healthcare burden of rCDI: 34% of patients with rCDI needed admission, 28% developed severe CDI, and 4% developed a complication. Secular changes in the severity of recurrences could reflect variations in the predominant strain, or better management.

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Face shields for infection control: A review

Roberge, R. J.  Journal of Occupational and Environmental Hygiene. Volume 13, Issue 4, 2016

N0037783 A male surgeon during an operation
Image source: Slyvain Teissier – Wellcome Images

Face shields are personal protective equipment devices that are used by many workers (e.g., medical, dental, veterinary) for protection of the facial area and associated mucous membranes (eyes, nose, mouth) from splashes, sprays, and spatter of body fluids. Face shields are generally not used alone, but in conjunction with other protective equipment and are therefore classified as adjunctive personal protective equipment.

Although there are millions of potential users of face shields, guidelines for their use vary between governmental agencies and professional societies and little research is available regarding their efficacy.

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Hand hygiene compliance: are we kidding ourselves?

Mahinda, N. Journal of Hospital Infection. Available online 27 February 2016

NHS Framework Documant 2008Hand hygiene is one of the main strategies for reducing the incidence of healthcare-associated infections (HCAIs) and it is included in a number of national and international guidelines.

The weight of evidence for hand hygiene in preventing HCAIs has steadily increased from Semmelweis’s clinical experience in the nineteenth century to numerous studies to date.

One would therefore expect, in an age of evidence-based medicine, that compliance with hand hygiene could be taken for granted. Instead, the opposite is true, with studies showing hand hygiene compliance among healthcare workers (HCWs) remaining at low levels.

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Lessons learned from a prolonged and costly norovirus outbreak at a Scottish medicine of the elderly hospital: case study

Danial, J. et al.  Journal of Hospital Infection. Available online 26 February 2016

B0003420 Norovirus - colour-enhanced
Image source: David Gragory & Debbie Marshall – Wellcome Images

Image shows colour-enhanced, electron micrograph of the Norovirus.

Background: Norovirus outbreaks are a major burden for healthcare facilities globally.

Aim: Lessons learned to inform an action plan to improve facilities as well as responses to norovirus within the medicine of the elderly (MoE) hospital as well as other NHS (National Health Service) Lothian facilities.

Methods: This study investigated the impact of a prolonged outbreak at an MoE hospital in one of the 14 Scottish health boards between February and March 2013.

Findings: In all, 143 patients (14.80 cases per 1000 inpatient bed-days) and 30 healthcare staff (3.10 cases per 1000 inpatient bed-days) were affected clinically and 63 patients were confirmed virologically. Restricting new admissions to affected units resulted in 1192 lost bed-days. The cost due to lost bed-days in addition to staff absence and management of the outbreak was estimated at £341,534 for this incident alone. At certain points during the outbreak, the whole facility was closed with resulting major impact on the health board’s acute care hospitals.

Conclusion: Due to the outbreak, new measures were implemented for the first time within NHS Lothian that included floor-by-floor (instead of individual) ward closures, enhanced cleaning with chlorine-based products throughout the hospital, reduction in bed capacity with enhanced bed-spacing and interruption to direct admissions from the Board’s general practice surgeries, and temporary suspension of visitors to affected areas. Together with regular communication to staff, patients, relatives, and the public throughout the outbreak and good engagement of staff groups in management of the incident, the outbreak was gradually brought under control.

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The Feasibility of an Infection Control “Safe Zone” in a Spinal Cord Injury Unit

Lones, K. et al. Infection Control & Hospital Epidemiology . Article published online 26th February 2016.

We report on healthcare worker use of a safe zone (outside a 3-foot perimeter around the patient’s bed) and personal protective equipment in 2 inpatient spinal cord injury/disorder units.

Workers remained within the safe zone during 22% of observations but were less compliant with personal protective equipment inside the zone.

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Healthcare-associated infections NICE quality standard [QS113]

This new quality standard covers organisational factors in preventing and controlling healthcare-associated infections in secondary care settings.

NICE quality standards describe high-priority areas for quality improvement in a defined care or service area. Each standard consists of a prioritised set of specific, concise and measurable statements. They draw on existing guidance, which provides an underpinning, comprehensive set of recommendations, and are designed to support the measurement of improvement.

This quality standard covers organisational factors in preventing and controlling healthcare-associated infections in secondary care settings.

Organisational factors include management arrangements, policies, procedures, monitoring, evaluation, audit and accountability.

Secondary care settings include hospital buildings and grounds; inpatient, day case and outpatient facilities and services; elective and emergency care facilities; and hospital maternity units and services.

nICE infections

View the full quality standard here