Research for infection protection
  • germs
  • Adenovirus
  • Aspergillus niger
  • Bovine virus diarrhea
  • Clostridium difficile
  • Candida albicans
  • Candida albicans
  • Coronavirus
  • Corynebacterium
  • Escherichia coli
  • Helicobacter pylori

Author: McDonald LC et al. Source: Morbidity and Mortality Weekly Report (MMWR), March 9, 2012 / 61(09);157-162


McDonald LC et al.

Vital Signs: Preventing Clostridium difficile Infections

Background: Clostridium difficile infection (CDI) belongs to the most common healthcare-associated infection: In the U.S., incidence and death rates as well as excess healthcare costs resulting from CDIs in hospitalised patients have reached all-time highs. However, so far, it has not been demonstrated to which extent nonhospital healthcare exposures contribute to the overall burden of CDI and whether programmes including the implementation of Centers for Disease Control and Prevention (CDC) recommendations across a range of hospitals are capable of preventing CDI.

Methods: In this investigation conducted in the U.S., three data sources were analysed to identify healthcare exposures to CDIs, determine the proportion of CDIs occurring outside hospital settings, and assess whether prevention programmes can effectively reduce the rate of CDI. The data sources were (a) the CDC’s population-based surveillance programme for CDIs (Emerging Infections Program); (b) the National Healthcare Safety Network (NHSN) Multidrug-Resistant Organism and Clostridium difficile Infection module for laboratory-identified CDI events; and (c) early results from three state-led programmes in which 71 hospitals collaborate with one another to prevent intrahospital transmission of Clostridium difficile.

Results: 94 % of CDIs identified in Emerging Infections Program data in 2010 were associated with receiving health care, and 75 % of these had onset among people not currently hospitalised (e.g. recently discharged patients, outpatients, nursing home residents). Among CDIs reported to NHSN in 2010, 52 % were already present on hospital admission, although a large proportion was nevertheless related to health care. The pooled CDI rate in the 71 hospitals participating in the CDI prevention programs declined 20%.

Conclusions: The analysis of the three data sources shows that nearly all CDIs are related to various healthcare settings where Clostridium difficile transmission occurs, and that hospital-onset CDIs could be prevented by an emphasis on infection control. According to the authors, there is still more that needs to be done to prevent CDIs across all healthcare settings: Major reductions will require antimicrobial stewardship programmes along with infection control in hospitals, nursing homes and outpatient-care settings. In addition, state health departments and partner organisations assuming a leading role in preventing CDIs in hospitals should extend their programmes to also include other healthcare settings.

Morbidity and Mortality Weekly Report (MMWR), March 9, 2012 / 61(09);157-162

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