Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization.
<h4>Background</h4>Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea.<h4>Objective</h4>Assess the impact of admission testing for toxigenic C. difficile colonization on...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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Public Library of Science (PLoS)
2020-01-01
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| Series: | PLoS ONE |
| Online Access: | https://doi.org/10.1371/journal.pone.0230475 |
| _version_ | 1818740653935296512 |
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| author | Lance R Peterson Sean O'Grady Mary Keegan Adrienne Fisher Shane Zelencik Bridget Kufner Mona Shah Rachel Lim Donna Schora Sanchita Das Kamaljit Singh |
| author_facet | Lance R Peterson Sean O'Grady Mary Keegan Adrienne Fisher Shane Zelencik Bridget Kufner Mona Shah Rachel Lim Donna Schora Sanchita Das Kamaljit Singh |
| author_sort | Lance R Peterson |
| collection | DOAJ |
| description | <h4>Background</h4>Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea.<h4>Objective</h4>Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI.<h4>Design</h4>Pragmatic stepped-wedge Infection Control initiative.<h4>Setting</h4>NorthShore University HealthSystem is a four-hospital system near Chicago, IL.<h4>Patients</h4>All patients admitted to the four hospitals during the initiative.<h4>Interventions</h4>From September 2017 through August 2018 we conducted a quality improvement program where admitted patients had a peri-rectal swab tested for toxigenic C. difficile. All colonized patients were placed into contact precautions.<h4>Measurements</h4>We tested admissions who: i) had been hospitalized within two months, ii) had a past C. difficile positive test, and/or iii) were in a long-term care facility within six months. We measured compliance with all other practices to reduce the incidence of HO-CDI.<h4>Results</h4>30% of admissions were tested and 8.3% were positive. In the year prior to the initiative (Period 1) there were 63,057 admitted patients when HO-CDI incidence was 5.96 cases/10,000 patient days. During the 12-month initiative (Period 2) there were 62,760 admissions and the HO-CDI incidence was 4.23 cases/10,000 patient days (p = 0.02). There were no other practice or antibiotic use changes. Continuing admission surveillance provided a HO-CDI incidence of 2.9 cases/10,000 patient days during the final 9 months of 2018 (p<0.0001 compared to Period 1), equaling <1 case/1,000 admissions.<h4>Limitations</h4>This was not a randomized controlled trial, and multiple prevention practices were in place at the time of the admission surveillance initiative.<h4>Conclusion</h4>Admission C. difficile surveillance testing is an important tool for preventing hospital-onset C. difficile infection.<h4>Registration</h4>This quality improvement initiative is registered at ClinicalTrials.gov. The unique registration identifier number is NCT04014608. |
| first_indexed | 2024-12-18T01:44:09Z |
| format | Article |
| id | doaj.art-4904288caf6c48f6b5474136778ca567 |
| institution | Directory Open Access Journal |
| issn | 1932-6203 |
| language | English |
| last_indexed | 2024-12-18T01:44:09Z |
| publishDate | 2020-01-01 |
| publisher | Public Library of Science (PLoS) |
| record_format | Article |
| series | PLoS ONE |
| spelling | doaj.art-4904288caf6c48f6b5474136778ca5672022-12-21T21:25:14ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01153e023047510.1371/journal.pone.0230475Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization.Lance R PetersonSean O'GradyMary KeeganAdrienne FisherShane ZelencikBridget KufnerMona ShahRachel LimDonna SchoraSanchita DasKamaljit Singh<h4>Background</h4>Clostridioides difficile Infection (CDI) is a persistent healthcare issue. In the US, CDI is the most common infectious cause of hospital-onset (HO) diarrhea.<h4>Objective</h4>Assess the impact of admission testing for toxigenic C. difficile colonization on the incidence of HO-CDI.<h4>Design</h4>Pragmatic stepped-wedge Infection Control initiative.<h4>Setting</h4>NorthShore University HealthSystem is a four-hospital system near Chicago, IL.<h4>Patients</h4>All patients admitted to the four hospitals during the initiative.<h4>Interventions</h4>From September 2017 through August 2018 we conducted a quality improvement program where admitted patients had a peri-rectal swab tested for toxigenic C. difficile. All colonized patients were placed into contact precautions.<h4>Measurements</h4>We tested admissions who: i) had been hospitalized within two months, ii) had a past C. difficile positive test, and/or iii) were in a long-term care facility within six months. We measured compliance with all other practices to reduce the incidence of HO-CDI.<h4>Results</h4>30% of admissions were tested and 8.3% were positive. In the year prior to the initiative (Period 1) there were 63,057 admitted patients when HO-CDI incidence was 5.96 cases/10,000 patient days. During the 12-month initiative (Period 2) there were 62,760 admissions and the HO-CDI incidence was 4.23 cases/10,000 patient days (p = 0.02). There were no other practice or antibiotic use changes. Continuing admission surveillance provided a HO-CDI incidence of 2.9 cases/10,000 patient days during the final 9 months of 2018 (p<0.0001 compared to Period 1), equaling <1 case/1,000 admissions.<h4>Limitations</h4>This was not a randomized controlled trial, and multiple prevention practices were in place at the time of the admission surveillance initiative.<h4>Conclusion</h4>Admission C. difficile surveillance testing is an important tool for preventing hospital-onset C. difficile infection.<h4>Registration</h4>This quality improvement initiative is registered at ClinicalTrials.gov. The unique registration identifier number is NCT04014608.https://doi.org/10.1371/journal.pone.0230475 |
| spellingShingle | Lance R Peterson Sean O'Grady Mary Keegan Adrienne Fisher Shane Zelencik Bridget Kufner Mona Shah Rachel Lim Donna Schora Sanchita Das Kamaljit Singh Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. PLoS ONE |
| title | Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. |
| title_full | Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. |
| title_fullStr | Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. |
| title_full_unstemmed | Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. |
| title_short | Reduced Clostridioides difficile infection in a pragmatic stepped-wedge initiative using admission surveillance to detect colonization. |
| title_sort | reduced clostridioides difficile infection in a pragmatic stepped wedge initiative using admission surveillance to detect colonization |
| url | https://doi.org/10.1371/journal.pone.0230475 |
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