Assessing the burden of Clostridium difficile infections for hospitals

Nosocomial infections place a heavy burden on the healthcare system. However, quantifying the burden raises many questions, ranging from the way to accurately estimate the extra length of stay at hospital to defining and costing the preventative methods among the different care providers | Journal of Hospital Infection

B0008374 Clostridium difficile colony

Image source: David Goulding, Wellcome Trust Sanger Institute – Wellcome Images // CC BY 4.0

A total of 52 episodes were screened during the study period. The estimated mean cost of CDI was approximately €23,909 (SD = 17,458) for an extended length of hospital stay (N = 27). In the case of a reduced length of the hospital stay (N = 25), the mean cost was approximately € –14,697 (SD = 16,936), which represents net savings for the hospitals. The main cost/savings driver was the productivity losses/gains resulting from the nosocomial infection. A sensitivity analysis showed that the main factor explaining the amount of costs or savings due to nosocomial infections was the length of the hospital stay.

Conclusion: We discuss the notion of productivity gains in the case of deaths as a factor revealing the incompleteness of the payment systems. We then discuss the methodological issues associated with the statistical method used to control for temporality bias.

Full reference: Hebbinckuys, E. et al. (2017) Assessing the burden of Clostridium difficile infections for hospitals. Journal of Hospital Infection. Published online: September 07, 2017

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Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center?

Highlights: 

  • An educational intervention study was completed to improve patient hand hygiene opportunities for patients at a large academic medical center.
  • After the intervention, it was possible to study the effects of improved patient hand hygiene on health care facility–onset Clostridium difficile infection events.
  • C difficile infection events decreased significantly (P ≤ .05) for 6 months after the intervention.
  • Patient hand hygiene may be an underused prevention measure for C difficile disease; successful implementation requires staff to engage the patient with opportunities, reminders, and encouragement to keep their hands clean

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Full reference: Pokrywka, M. et al. (2017) Can improving patient hand hygiene impact Clostridium difficile infection events at an academic medical center? American Journal of Infection Control. Vol. 45 (Issue 9) pp. 959–963

Antimicrobial stewardship program and Clostridium difficile

Institutional antimicrobial stewardship programs seek to decrease the occurrence of C difficile by implementing strategies to address antibiotic usage; however, optimal structure and strategies for accomplishing this remain largely unknown | American Journal of Infection Control

A colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Image source: Annie Cavanagh – Wellcome Images // CC BY-NC-ND 4.0

Image shows a colour-enhanced scanning electron micrograph image showing a cluster of Clostridium difficile on a surface.

Highlights: 

  • More hospitals with non-better Clostridium difficile rank used prospective audit and feedback.
  • More better C difficile rank hospitals used a preauthorization strategy.
  • More better C difficile rank hospitals restricted more high-risk antibiotics.

Full reference: Barlow, G. et al. (2017) Associations between antimicrobial stewardship program elements and Clostridium difficile infection performance. American Journal of Infection Control. Published online: 27 July 2017.

Tobacco use as a screener for Clostridium difficile infection outcomes

A retrospective cohort study to evaluate the utility of self-reported tobacco use for developing a clinical prediction rule for poor outcomes of Clostridium difficile infection | Journal of Hospital Infection

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We found that patients with any history of smoking were significantly less likely than never smokers to be cured of their infection within two weeks. Disease recurrence, readmission within thirty days, death before treatment completion, and the severity of Clostridium difficile infection were not associated with smoking status.

Full reference: Barker, A.K. et al. (2017) Tobacco use as a screener for Clostridium difficile infection outcomes. Journal of Hospital Infection. Published online: 26 June 2017

Are alcohol-based dispensers fomites for C difficile?

The purpose of this study was to evaluate alcohol-based dispensers as potential fomites for Clostridium difficile | American Journal of Infection Control

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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.

Full reference: Hall, J.A. et al. (2017) Dipping into the Clostridium difficile pool: Are alcohol-based dispensers fomites for C difficile? American Journal of Infection Control. DOI: 10.1016/j.ajic.2017.04.284

Risk Factors for Community-Associated Clostridium difficile Infection in Children

Adams, D.J. et al. The Journal of Pediatrics | Published online: 7 April 2017

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Objective: To characterize the medication and other exposures associated with pediatric community-associated Clostridium difficile infections (CA-CDIs).

Conclusions: CA-CDI is associated with medications regularly prescribed in pediatric practice, along with exposure to outpatient healthcare clinics and family members with CDI. Our findings provide additional support for the judicious use of these medications and for efforts to limit spread of CDI in ambulatory healthcare settings and households.

Read the full abstract here

Clostridium difficile: still costly, still difficult to treat, and still here

Trafford, G. Journal of Hospital Infection | Published online: 18 March 2017

Clostridium difficile infection (CDI) remains a formidable problem in the healthcare setting and there is much left to learn regarding the biology of this troublesome pathogen. This special section in this issue of the Journal contains a range of papers covering the epidemiology, treatment, and costs of CDI. Individual cases and outbreaks come at considerable cost to institutions, with the subset of patients who fail to respond to conventional antibiotic therapy presenting an even greater morbidity risk and cost largely due to increased length of stay

Read the abstract here