Hostname: page-component-848d4c4894-2pzkn Total loading time: 0 Render date: 2024-05-18T23:42:17.172Z Has data issue: false hasContentIssue false
  • English
  • Français

Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention

Published online by Cambridge University Press:  16 March 2017

Irene K. Louh ,
William G. Greendyke ,
Emilia A. Hermann ,
Karina W. Davidson ,
Louise Falzon ,
David K. Vawdrey ,
Jonathan A. Shaffer ,
David P. Calfee ,
E. Yoko Furuya  and
Henry H. Ting
Irene K. Louh
Affiliation:
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York New York-Presbyterian Hospital, New York, New York
William G. Greendyke
Affiliation:
Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York New York-Presbyterian Hospital, New York, New York
Emilia A. Hermann
Affiliation:
Division of General Medicine, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York New York-Presbyterian Hospital, New York, New York
Karina W. Davidson
Affiliation:
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
Louise Falzon
Affiliation:
Center for Behavioral Cardiovascular Health, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
David K. Vawdrey
Affiliation:
New York-Presbyterian Hospital, New York, New York Department of Biomedical Informatics, Columbia University College of Physicians and Surgeons, New York, New York
Jonathan A. Shaffer
Affiliation:
Department of Psychology, University of Colorado Denver, Denver, Colorado
David P. Calfee
Affiliation:
New York-Presbyterian Hospital, New York, New York Division of Infectious Diseases, Department of Medicine, Weill Cornell Medical College, New York, New York
E. Yoko Furuya
Affiliation:
Division of Infectious Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York New York-Presbyterian Hospital, New York, New York
Henry H. Ting*
Affiliation:
New York-Presbyterian Hospital, New York, New York Division of Cardiovascular Diseases, Department of Medicine, Columbia University College of Physicians and Surgeons, New York, New York
*
Address correspondence to Henry H. Ting, MD, MBA, Columbia University Medical College, 622 W 168th St, New York, NY 10032 (hting@nyp.org).
Get access Rights & Permissions [Opens in a new window]

Abstract

OBJECTIVE

Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009.

DESIGN

We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015.

SETTING

We included studies performed in acute-care hospitals.

PATIENTS OR PARTICIPANTS

We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates.

INTERVENTIONS

We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible.

RESULTS

Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates.

CONCLUSIONS

Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates.

Infect Control Hosp Epidemiol 2017;38:476–482

Type
Review Article
Information
Infection Control & Hospital Epidemiology , Volume 38 , Issue 4 , April 2017 , pp. 476 - 482
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.)

References

REFERENCES

1. Leffler, DA, Lamont, JT. Clostridium difficile infection. N Engl J Med 2015;372:1539–1548.CrossRefGoogle ScholarPubMed
2. Lofgren, ET, Cole, SR, Weber, DJ, et al. Hospital-acquired Clostridium difficile infections: estimating all-cause mortality and length of stay. Epidemiology 2014;25:570–575.CrossRefGoogle ScholarPubMed
3. Goldstein, EJ, Johnson, S, Maziade, PJ, et al. Pathway to prevention of nosocomial Clostridium difficile infection. Clin Infect Dis 2015;60:S148–S158.CrossRefGoogle ScholarPubMed
4. Yokoe, DS, Anderson, DJ, Berenholtz, SM, et al; Society for Healthcare Epidemiology of America (SHEA). A compendium of strategies to prevent healthcare-associated infections in acute care hospitals: 2014 updates. Infect Control Hosp Epidemiol 2014;35:967–977.CrossRefGoogle ScholarPubMed
5. Dubberke, ER, 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
6. Hsu, J, Abad, C, Dinh, M, Safdar, N. Prevention of endemic healthcare-associated Clostridium difficile infection: reviewing the evidence. Am J Gastroenterol 2010;105:2327–2339.CrossRefGoogle ScholarPubMed
7. Hempel, S, Shekelle, PG, Liu, JL, et al. Development of the Quality Improvement Minimum Quality Criteria Set (QI-MQCS): a tool for critical appraisal of quality improvement intervention publications. BMJ Qual Saf 2015;24:796–804.CrossRefGoogle ScholarPubMed
8. Orenstein, R, Aronhalt, KC, McManus, JE Jr, Fedraw, LA. A targeted strategy to wipe out Clostridium difficile . Infect Control Hosp Epidemiol 2011;32:1137–1139.CrossRefGoogle ScholarPubMed
9. Hacek, DM, Ogle, AM, Fisher, A, et al. Significant impact of terminal room cleaning with bleach on reducing nosocomial Clostridium difficile . Am J Infect Control 2010;38:350–353.CrossRefGoogle ScholarPubMed
10. Levin, J, Riley, LS, Parrish, C, et al. The effect of porTABLE pulsed xenon ultraviolet light after terminal cleaning on hospital-associated Clostridium difficile infection in a community hospital. Am J Infect Control 2013;41:746–748.CrossRefGoogle Scholar
11. Haas, JP, Menz, J, Dusza, S, Montecalvo, MA. Implementation and impact of ultraviolet environmental disinfection in an acute care setting. Am J Infect Control 2014;42:586–590.CrossRefGoogle Scholar
12. Yam, P, Fales, D, Jemison, J, et al. Implementation of an antimicrobial stewardship program in a rural hospital. Am J Health-Syst Pharm 2012;69:1142–1148.CrossRefGoogle Scholar
13. Dancer, SJ, Kirkpatrick, P, Corcoran, DS, et al. Approaching zero: temporal effects of a restrictive antibiotic policy on hospital-acquired Clostridium difficile, extended-spectrum β-lactamase-producing coliforms and meticillin-resistant Staphylococcus aureus . Int J Antimicrob Agents 2013;41:137–142.CrossRefGoogle ScholarPubMed
14. Jenkins, TC, Knepper, BC, Shihadeh, K, et al. Long-term outcomes of an antimicrobial stewardship program implemented in a hospital with low baseline antibiotic use. Infect Control Hosp Epidemiol 2015;36:664–672.CrossRefGoogle Scholar
15. Borde, JP, Litterst, S, Ruhnke, M, et al. Implementing an intensified antibiotic stewardship programme targeting cephalosporin and fluoroquinolone use in a 200-bed community hospital in Germany. Infection 2015;43:45–50.CrossRefGoogle Scholar
16. Kirkland, KB, Homa, KA, Lasky, RA, et al. Impact of a hospital-wide hand hygiene initiative on healthcare-associated infections: results of an interrupted time series. BMJ Qual Saf 2012;21:1019–1026.CrossRefGoogle ScholarPubMed
17. Doron, SI, Kifuji, K, Hynes, BT, et al. A multifaceted approach to education, observation, and feedback in a successful hand hygiene campaign. Jt Comm J Qual Patient Saf 2011;37:3–10.Google Scholar
18. Stone, SP, Fuller, C, Savage, J, et al. Evaluation of the national Cleanyourhands campaign to reduce Staphylococcus aureus bacteraemia and Clostridium difficile infection in hospitals in England and Wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study. BMJ 2012;344:e3005.CrossRefGoogle ScholarPubMed
19. Knight, N, Strait, T, Anthony, N, et al. Clostridium difficile colitis: a retrospective study of incidence and severity before and after institution of an alcohol-based hand rub policy. Am J Infect Control 2010;38:523–528.CrossRefGoogle ScholarPubMed
20. Popovich, KJ, Hota, B, Hayes, R, et al. Effectiveness of routine patient cleansing with chlorhexidine gluconate for infection prevention in the medical intensive care unit. Infect Control Hosp Epidemiol 2009;30:959–963.CrossRefGoogle ScholarPubMed
21. Noto, MJ, Domenico, HJ, Byrne, DW, et al. Chlorhexidine bathing and health care-associated infections: a randomized clinical trial. JAMA 2015;313:369–378.CrossRefGoogle ScholarPubMed
22. Kassakian, SZ, Mermel, LA, Jefferson, JA, et al. Impact of chlorhexidine bathing on hospital-acquired infections among general medical patients. Infect Control Hosp Epidemiol 2011;32:238–243.CrossRefGoogle ScholarPubMed
23. Rupp, ME, Cavalieri, RJ, Lyden, E, et al. Effect of hospital-wide chlorhexidine patient bathing on healthcare-associated infections. Infect Control Hosp Epidemiol 2012;33:1094–1100.CrossRefGoogle ScholarPubMed
24. Maziade, PJ, Andriessen, JA, Pereira, P, et al. Impact of adding prophylactic probiotics to a bundle of standard preventative measures for Clostridium difficile infections: enhanced and sustained decrease in the incidence and severity of infection at a community hospital. Curr Med Res Opin 2013;29:1341–1347.CrossRefGoogle Scholar
25. Maziade, PJ, Pereira, P, Goldstein, EJ. A decade of experience in primary prevention of Clostridium difficile infection at a community hospital using the probiotic combination Lactobacillus acidophilus CL1285, Lactobacillus casei LBC80R, and Lactobacillus rhamnosus CLR2 (Bio-K+). Clin Infect Dis 2015;60:S144–S147.CrossRefGoogle Scholar
26. Flatley, EA, Wilde, AM, Nailor, MD. Saccharomyces boulardii for the prevention of hospital onset Clostridium difficile infection. J Gastrointestin Liver Dis 2015;24:21–24.CrossRefGoogle ScholarPubMed
27. Elligsen, M, Walker, SA, Pinto, R, et al. Audit and feedback to reduce broad-spectrum antibiotic use among intensive care unit patients: a controlled interrupted time series analysis. Infect Control Hosp Epidemiol 2012;33:354–361.CrossRefGoogle ScholarPubMed
28. Cook, PP, Rizzo, S, Gooch, M, et al. Sustained reduction in antimicrobial use and decrease in methicillin-resistant Staphylococcus aureus and Clostridium difficile infections following implementation of an electronic medical record at a tertiary-care teaching hospital. J Antimicrob Chemother 2011;66:205–209.CrossRefGoogle Scholar
29. Cheng, VC, Chau, PH, 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
30. Abbett, SK, Yokoe, DS, 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
31. Miller, R, Simmons, S, Dale, C, et al. Utilization and impact of a pulsed-xenon ultraviolet room disinfection system and multidisciplinary care team on Clostridium difficile in a long-term acute care facility. Am J Infect Control 2015;43:1350–1353.CrossRefGoogle Scholar
32. Aldeyab, MA, Devine, MJ, Flanagan, P, et al. Multihospital outbreak of Clostridium difficile ribotype 027 infection: epidemiology and analysis of control measures. Infect Control Hosp Epidemiol 2011;32:210–219.CrossRefGoogle ScholarPubMed
33. Aldeyab, MA, Kearney, MP, Scott, MG, et al. An evaluation of the impact of antibiotic stewardship on reducing the use of high-risk antibiotics and its effect on the incidence of Clostridium difficile infection in hospital settings. J Antimicrob Chemother 2012;67:2988–2996.CrossRefGoogle ScholarPubMed
34. Bryce, E, Grant, J, Scharf, S, et al. Horizontal infection prevention measures and a risk-managed approach to vancomycin-resistant Enterococci: an evaluation. Am J Infect Control 2015;43:1238–1243.CrossRefGoogle Scholar
35. 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
36. 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
37. Pokrywka, M, Feigel, J, Douglas, B, et al. A bundle strategy including patient hand hygiene to decrease Clostridium difficile infections. Medsurg Nurs 2014;23:145–148, 164.Google ScholarPubMed
38. Brakovich, B, Bonham, E, VanBrackle, L. War on the spore: Clostridium difficile disease among patients in a long-term acute care hospital. Jr Healthcare Qual 2013;35:15–21.CrossRefGoogle Scholar
39. Weiss, K, Boisvert, 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. 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
41. 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
42. 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
43. Cohen, SH, Gerding, DN, 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 infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol 2010;31:431–455.CrossRefGoogle Scholar
44. Wagner, B, Filice, GA, Drekonja, D, et al. Antimicrobial stewardship programs in inpatient hospital settings: a systematic review. Infect Control Hosp Epidemiol 2014;35:1209–1228.CrossRefGoogle ScholarPubMed
45. Feazel, LM, Malhotra, A, Perencevich, EN, et al. Effect of antibiotic stewardship programmes on Clostridium difficile incidence: a systematic review and meta-analysis. J Antimicrob Chemother 2014;69:1748–1754.CrossRefGoogle ScholarPubMed
46. Johnston, BC, Ma, SS, Goldenberg, JZ, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea: a systematic review and meta-analysis. Ann Intern Med 2012;157:878–888.CrossRefGoogle ScholarPubMed
47. Goldenberg, JZ, Ma, SS, Saxton, JD, et al. Probiotics for the prevention of Clostridium difficile-associated diarrhea in adults and children. Cochrane Database Syst Rev 2013. 5):CD006095.Google ScholarPubMed
48. Knelson, LP, Ramadanovic, G, Chen, LF, et al. Self-monitoring of hospital room cleaning by Environmental Services (EVS) may not accurately measure cleanliness. Presented at IDWeek 2015; October 7–11, 2015; San Diego, CA.Google Scholar
49. Manian, FA, Griesnauer, S, Bryant, A. Implementation of hospital-wide enhanced terminal cleaning of targeted patient rooms and its impact on endemic Clostridium difficile infection rates. Am J Infect Control 2013;41:537–541.CrossRefGoogle ScholarPubMed
50. Kallen, AJ, Thompson, A, Ristaino, P, et al. Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital. Infect Control Hosp Epidemiol 2009;30:264–272.CrossRefGoogle Scholar
51. Chan, YY, Lin, TY, Huang, CT, et al. Implementation and outcomes of a hospital-wide computerised antimicrobial stewardship programme in a large medical centre in Taiwan. Int J Antimicrob Agents 2011;38:486–492.CrossRefGoogle Scholar
52. Lee, TC, Frenette, C, Jayaraman, D, et al. Antibiotic self-stewardship: trainee-led structured antibiotic time-outs to improve antimicrobial use. Ann Intern Med 2014;161:S53–S58.CrossRefGoogle ScholarPubMed
53. Nowak, MA, Nelson, RE, Breidenbach, JL, et al. Clinical and economic outcomes of a prospective antimicrobial stewardship program. Am J Health Syst Pharm 2012;69:1500–1508.CrossRefGoogle ScholarPubMed
54. Talpaert, MJ, Gopal Rao, G, Cooper, BS, Wade, P. Impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of Clostridium difficile infection. J Antimicrob Chemother 2011;66:2168–2174.CrossRefGoogle ScholarPubMed
55. Cruz-Rodríguez, NC, Hernández-García, R, Salinas-Caballero, AG, et al. The effect of pharmacy restriction of clindamycin on Clostridium difficile infection rates in an orthopedics ward. Am J Infect Control 2014;42:e71–e73.CrossRefGoogle Scholar
56. Sarma, JB, Marshall, B, Cleeve, V, et al. Effects of fluoroquinolone restriction (from 2007 to 2012) on Clostridium difficile infections: interrupted time-series analysis. J Hosp Infect 2015;91:74–80.CrossRefGoogle ScholarPubMed
57. Yu, K, Rho, J, Morcos, M, et al. Evaluation of dedicated infectious diseases pharmacists on antimicrobial stewardship teams. Am J Health Syst Pharm 2014;71:1019–1028.CrossRefGoogle ScholarPubMed
58. Bearman, G, Rosato, AE, Duane, TM, et al. Trial of universal gloving with emollient-impregnated gloves to promote skin health and prevent the transmission of multidrug-resistant organisms in a surgical intensive care unit. Infect Control Hosp Epidemiol 2010;31:491–497.CrossRefGoogle Scholar
59. Sulis, CA, Walkey, AJ, Abadi, Y, et al. Outcomes of a ventilator-associated pneumonia bundle on rates of ventilator-associated pneumonia and other health care-associated infections in a long-term acute care hospital setting. Am J Infect Control 2014;42:536–538.CrossRefGoogle Scholar
60. Amer, MR, Akhras, NS, Mahmood, WA, et al. Antimicrobial stewardship program implementation in a medical intensive care unit at a tertiary care hospital in Saudi Arabia. Ann Saudi Med 2013;33:547–554.CrossRefGoogle Scholar
Supplementary material: PDF

Louh supplementary material

Louh supplementary material

Download Louh supplementary material(PDF)
PDF 195.6 KB