Not only can the hands of healthcare personnel serve as reservoirs of C. diff, but equipment and surfaces can as well. It’ s critical to adequately clean and disinfect the equipment and surfaces in the environment of C. diff patients, including having environmental services protocols for how that’ s conducted, especially for shared equipment and other noncritical patient-care items.”— Larry Kociolek, MD, MSCI, FSHEA, FPIDS
years) hospitalizations, respectively. After adjusting for differences in clinical characteristics, there was no significant reduction in CDI incidence( pre-AI period: 5.76 per 10 000 patient-days vs post-AI period: 5.65 per 10 000 patient-days; absolute difference, −0.11; 95 % CI, −1.43 to 1.18; P =. 85). Relative reductions greater than 10 percent in normalized antimicrobial days were seen for piperacillin-tazobactam( −9.64; 95 % CI, −12.93 to −6.28; P <. 001) and clindamycin( −1.04; 95 % CI, −1.60 to −0.47; P =. 03), especially for high-risk patients alerted by AI( relative reduction for piperacillin-tazobactam, 16.8 %; 95 % CI, 8.0 %-24.6 %). Based on qualitative assessments via semi-structured interviews and field observations, the study found that healthcare staff’ s experiences with AI-guided workflows varied. In particular, the enhanced hand hygiene protocols were met with poor adherence, whereas pharmacists consistently engaged with the alerts.
Shenoy pointed to the authors’ use of two sets of interventions.“ The IPC bucket consisted of hand hygiene among patients who were at high risk for developing C. diff and antimicrobial stewardship interventions,” she explained.“ Among those, they were looking at a beta-lactam allergy consult, antimicrobial de-escalation, and a yogurt recommendation. They did this for a year and the outcomes they were looking at were C. diff incidents, antimicrobial use, and qualitative assessments of bundle implementation.”
Shenoy continued,“ In the IPC intervention bucket, it’ s about reducing exposure, trying to get people to say,‘ Look, your patient is at higher risk of C. diff, so perform enhanced hygiene.’ The second set of interventions were around reducing the susceptibility of patients who are at high risk, and they include educational interventions, a pharmacist medication review and a study team physician chart review to drive medication changes.”
During his presentation at the town hall event,“ 2022 CDI Compendium: The Old, The New, and the Unresolved,” panelist Larry Kociolek, MD, MSCI, FSHEA, FPIDS, attending physician and vice president of system preparedness, prevention and response at Ann & Robert H. Lurie Children’ s Hospital of Chicago, commented that,“ We have made a tremendous effort in progress around reducing C. diff infection, but the population burden is still profound. The recent estimates, which are a little bit dated now, but nearly 500,000 infections in the U. S. each year and more than 200,000 per year in hospitalized patients. We have seen overall C. diff incidents decrease over the past decade; that has been predominantly reflected in a dramatic drop in hospital-onset C. diff infection, so that’ s good that we are doing a better job in hospitals. But the number of community-associated C. diff that we are seeing has remained stable or even increasing, and in some studies, it’ s suggested that in some parts of the U. S., C. diff infections account for 50 percent or more of total C. diff infections in those areas.”
Kociolek continued,“ We know that C. diff prolongs hospital length of stay by anywhere from three to six days and it raises healthcare costs about $ 20,000 per episode with attributable costs ranging between $ 1 billion and $ 5 billion per year. It’ s not just a simple diarrheal illness; we know it’ s a significant proportion, up to 30 percent will experience at least one recurrence and that may be even higher in high-risk patients. And once you develop one recurrence, your risk goes up for recurrence even further. Patients are at risk of losing their colon from a severe C. diff infection, and up to about 1 percent of patients that’ ll happen to during endemic periods; we see about 5 percent mortality during endemic periods and approaching 15 percent to 20 percent during endemic periods and C. diff accounts for anywhere from 12 to 30,000 U. S. deaths per year.“
Kociolek explained that the findings of C. diff prevention from the studies as explored in the Compendium can be placed into two categories; one is the traditional infection control program of keeping hands, surfaces and equipment in hospitals clean, while the other is using contact precautions for patients with C. diff infection in their own rooms and other interventions, following guidelines for hand hygiene in terms of technique and using gowns and gloves to reduce patient-to-patient spread.“ We acknowledge that there can be some system challenges to these recommendations and that single-patient rooms may not always
be available. So, it’ s acceptable to co-hort patients with CDI, particularly when there aren’ t other transmissible infections that they’ re discordant foe, and we also need to ensure that we have adequate supplies of PPE to perform these measures. We should also follow appropriate criteria for discontinuing contact precautions which in general is at least 48 hours after the resolution of diarrhea but can be considered to be prolonged in some situations. You can consider adding further improvements in your C. difficile incidents in your institution, such as performing hand hygiene with soap and water rather than an alcohol-based handrub. I acknowledge that you may be taking a lot of these additional approaches. We know that alcohol does not inactivate spores; soap and water doesn’ t either, but the process of handwashing for 30 seconds and rinsing will likely reduce the amount of C. diff burden on hands. Another additional approach is rather than waiting for a C. diff test result to guide contact precautions to implement that once C. diff testing is pending, the impact on that will vary depending on the duration of time it takes to get that result. And then prolonging the duration of contact precautions beyond that 48-hour period following resolution of diarrhea is another thing you can consider.”
Kociolek added,“ Not only can the hands of healthcare personnel serve as reservoirs of C. diff, but equipment and surfaces can as well. It’ s critical to adequately clean and disinfect the equipment and surfaces in the environment of C. diff patients, including having environmental services protocols for how that’ s conducted, especially for shared equipment and other non-critical patient-care items. Not only is it important to have these policies, but it’ s important to ensure that personnel are following them correctly. That requires educating the environmental services staff as well as bedside healthcare providers to ensure they are doing things correctly. An additional approach is using a sporicidal disinfectant such as bleach for cleaning the environment of CDI patients. It is not something that has been shown to be consistently effective at driving down C. diff rates, particularly in an endemic situation, as it’ s thought that adequately cleaning with any disinfectant is enough to prevent transmission. A sporicidal is just something extra that can be used to try to drive down rates.”
He acknowledged that antimicrobial stewardship wasn’ t called out specifically in the multi-society Compendium because even though it was a best practice for reducing antimicrobial resistance, the data for the prevention of C. diff infections is just starting to emerge.“ As we make improvements in
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