Anna K Barker1,2, Elizabeth Scaria3, Oguzhan Alagoz1,3, Ajay K Sethi1, Nasia Safdar4,5. 1. Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. 2. Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan. 3. Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin. 4. Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin. 5. William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin.
Abstract
OBJECTIVE: Clostridioides difficile infection (CDI) is rapidly increasing in children's hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization. DESIGN: Agent-based simulation model of C. difficile transmission. SETTING: Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each. PARTICIPANTS: The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians. INTERVENTIONS: Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions. RESULTS: The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure. CONCLUSIONS: Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.
OBJECTIVE:Clostridioides difficileinfection (CDI) is rapidly increasing in children's hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization. DESIGN: Agent-based simulation model of C. difficile transmission. SETTING: Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each. PARTICIPANTS: The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians. INTERVENTIONS: Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions. RESULTS: The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure. CONCLUSIONS: Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.
Authors: Anna K Barker; Caitlyn Ngam; Jackson S Musuuza; Valerie M Vaughn; Nasia Safdar Journal: Infect Control Hosp Epidemiol Date: 2017-03-27 Impact factor: 3.254
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