N Khanafer1, N Voirin2, F Barbut3, E Kuijper4, P Vanhems2. 1. Epidemiology and Public Health Department, University of Lyon, Lyon, France; Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com. 2. Epidemiology and Public Health Department, University of Lyon, Lyon, France; Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils of Lyon, Lyon, France. 3. Pierre and Marie Curie University, Paris, France; National Reference Laboratory for C. difficile, Saint Antoine Hospital, Paris, France. 4. Department of Medical Microbiology, LUMC, Leiden, The Netherlands.
Abstract
BACKGROUND: The emergence of the epidemic Clostridium difficile 027 strain has renewed interest in infection control practices. AIM: To review the effectiveness of different practices to reduce hospital C. difficile infection (CDI) in non-outbreak settings. METHODS: Data sources were identified by a MEDLINE search in English and French. The ORION statement was used to extract key data from articles describing interventions to manage CDI. FINDINGS: Twenty-one studies, published between 1982 and December 2013, were reviewed. Most studies were before-after interventions, and a few studies were planned, formal, prospective investigations. The effects of the following single or combined interventions were described: antibiotic management; environmental disinfection and/or cleaning; hand hygiene; bathing; surveillance; cohorting; and isolation of infected patients in private rooms. CONCLUSION: With many methodological weaknesses and some inadequate research reporting, the observed reduction in CDI may not be entirely attributable to interventions. Although infection control programmes involving education and handwashing/gloving protocols were found to have contributed to a reduction in the incidence of CDI, these measures were usually a component of multi-faceted interventions that did not provide for evaluation of the relative impact of each factor. Appropriate environmental disinfection and antibiotic stewardship would appear to offer the most effective benefits.
BACKGROUND: The emergence of the epidemic Clostridium difficile 027 strain has renewed interest in infection control practices. AIM: To review the effectiveness of different practices to reduce hospital C. difficile infection (CDI) in non-outbreak settings. METHODS: Data sources were identified by a MEDLINE search in English and French. The ORION statement was used to extract key data from articles describing interventions to manage CDI. FINDINGS: Twenty-one studies, published between 1982 and December 2013, were reviewed. Most studies were before-after interventions, and a few studies were planned, formal, prospective investigations. The effects of the following single or combined interventions were described: antibiotic management; environmental disinfection and/or cleaning; hand hygiene; bathing; surveillance; cohorting; and isolation of infectedpatients in private rooms. CONCLUSION: With many methodological weaknesses and some inadequate research reporting, the observed reduction in CDI may not be entirely attributable to interventions. Although infection control programmes involving education and handwashing/gloving protocols were found to have contributed to a reduction in the incidence of CDI, these measures were usually a component of multi-faceted interventions that did not provide for evaluation of the relative impact of each factor. Appropriate environmental disinfection and antibiotic stewardship would appear to offer the most effective benefits.
Authors: N Kenters; E G W Huijskens; S C J de Wit; I G J M Sanders; J van Rosmalen; E J Kuijper; A Voss Journal: Antimicrob Resist Infect Control Date: 2017-06-03 Impact factor: 4.887