Multipronged Approach: Reducing Clostridioides Difficile Infections in Hospitals

The following is a summary of “Impact of a multipronged approach to reduce the incidence of Clostridioides difficile infections in hospitalized patients,” published in the June 2023 issue of Infection Control by Katzman et al.

The objective is to reduce Clostridioides difficile infections (CDI) in hospitalized patients, effective strategies are required. Researchers report data from three years preceding and three years after effective interventions, with a detailed analysis of all cases in the first year after implementation. 

Interventions included a nursing protocol to identify cases present on admission by asking if the patient had 1 or more liquid stools in the previous 24 hours and a 2-step testing algorithm in which samples positive by polymerase chain reaction (PCR) for the C. difficile toxin gene reflexed to an enzyme immunoassay (EIA) for the toxin antigen. Healthcare-associated infections due to CDI fell from ∼160 in each of the preceding 3 years to <65 in each of the subsequent 3 years (P<.001), while the ratio of observed-to-anticipated hospital-onset cases decreased to ∼0.50 (P<.02). 

About 395 samples were PCR(+) in the first year, but only 118 (29.9%) of these were EIA(+). 55 (46.6%) of the PCR(+)/EIA(+) samples from hospital day 1 or 2 were categorized as being present on admission. The average time between stool collection and PCR result reporting was ∼7.5 hours, while the EIA took an additional 68 minutes to report. Implementing an admission screening question and a two-step testing algorithm can substantially reduce incident CDI cases.

Source: sciencedirect.com/science/article/pii/S0196655322006629