reimbursement-negative incentive programs . While some facilities experienced increases in HO-CDI early in the COVID pandemic , recent more extensive studies have failed to document a significant trend in CDI rates .”
“ The CDI rate has plateaued and perhaps is no longer decreasing , but there was a benefit to the antimicrobial stewardship efforts over a four- or five-year period during which the national numbers drifted slightly downwards . Not gigantically , but certainly significantly , slowly , downward . I ’ m a very strong supporter of antimicrobial stewardship ( AS ) but the problem I see is that the impact on hospital-acquired C . diff may have reached a ceiling of benefit from AS . Most hospitals are doing fairly well with inpatient antimicrobial use , and they ’ ve come a long way in the last decade . And so , I think we might not see as much additional benefit over time . Since the pandemic , it ’ s been all over the place ; some hospitals have increases while a few saw decreases , and some facilities remained about the same . But nobody was keeping track during the pandemic , so the data was spotty and understandably so . I think the pandemic stalled progress ; I think there was probably some decrease in C . diff acquisition because of all the isolation precautions that were being taken in hospitals .”
Elements of Clostridioides difficile Environmental Epidemiology
➊ At the time of hospitalization 10.6 percent of patients are CD carriers
➋ During hospitalization 12.5 percent of patients are CD carriers
➌ Transmission of CD spores to environmental surfaces is associated with : Patients with acute infection ; patients recovering from acute infection ; and asymptomatic CD-colonized patients
➍ Treatment does not decrease ongoing environmental spore contamination for more than a month
➎ Widespread surface contamination far from known CD infected patients
➏ Increased cleaning and disinfection result in decreased surface and hand contamination and decreased CD acquisition
➐ Genomic confirmation of the role of asymptomatic CD carriers in transmission
➑ Acquisition of CD from a prior room occupant is significantly dependent on the prior room occupant receiving antibiotics
Source : Carling , et al . ( 2023 )