Electronic Clostridium difficile Infection Bundle Reduces Time to Initiation of Contact Precautions

2016 ◽  
Vol 38 (2) ◽  
pp. 242-244 ◽  
Author(s):  
Courtney M. Dewart ◽  
Natalia Blanco ◽  
Betsy Foxman ◽  
Anurag N. Malani
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Infect Control Hosp ◽  
Contact Precaution ◽  
Order Entry ◽  
Contact Precautions ◽  
Computerized Order Entry ◽  
Time To Initiation ◽  
The Impact ◽  
Reduced Time

The impact of computerized order-entry bundles on timing of contact precaution initiation for C. difficile infection (CDI) remains largely unexplored. Implementation of an electronic CDI prevention and management bundle that included an automatic isolation component significantly reduced time to initiation of contact precautions from 33.7 to 22.4 hours.Infect Control Hosp Epidemiol 2016;242–244

scholarly journals Perioperative Microbial Contamination From Patients on Contact Precaution in Operating Room Environment

2020 ◽  
Vol 41 (S1) ◽  
pp. s348-s349
Author(s):  
Hajime Kanamori ◽  
William Rutala ◽  
Maria Gergen ◽  
David Jay Weber
Keyword(s):  
Small Computer ◽  
Contact Precaution ◽  
Time Points ◽  
Contact Precautions ◽  
Surgery Patient ◽  
Patient Arrival ◽  
The Mean ◽  
Healthcare Associated ◽  
Cleaning And Disinfection ◽  
The Impact

Background: The contaminated healthcare environment, including operating rooms (ORs), can serve as an important role in transmission of healthcare-associated pathogens. Studies are very limited regarding the level of contamination of ORs during the surgery of a patient on contact precautions and the risk to the next surgery patient after standard room cleaning and disinfection. Objective: Here, we investigated the microbial burden on the OR environment when patients on contact precautions receive surgery, and we assessed the impact of cleaning and disinfection on the contamination of OR environmental sites. Methods: This investigation was conducted in the ORs of an academic facility during an 8-month period. It involved 10 patients on contact precautions for multidrug-resistant pathogens, including methicillin-resistant Staphylococcus aureus (MRSA; n = 7); carbapenem-resistant Enterobacteriaceae (CRE) plus MRSA (n = 2); and vancomycin-resistant Enterococcus (VRE) plus MRSA (n = 1), who underwent surgery. Environmental sampling was performed at the following time points: (1) immediately before the surgical patient’s arrival in the OR, (2) after surgery but before the OR cleaning and disinfection, and (3) after the OR cleaning and disinfection. In total, 1,520 environmental samples collected from 15 OR sites for 10 surgical patients at 3 time points were analyzed. Relatedness among environmental MRSA isolates was determined by pulsed-field gel electrophoresis. Results: Overall, the mean CFUs of aerobes per Rodac plate (CFU/25 cm2) were 10.1 before patient arrival, 14.7 before cleaning and disinfection, and 6.3 after cleaning and disinfection (P < .0001, after cleaning and disinfection vs before cleaning and disinfection). Moreover, 7 environmental sites (46.7%) after cleaning and disinfection, including bed, arm rest, pyxis counter, floor (near, door side), floor (far, by door), steel counter (small, near bed), and small computer desk, had significantly lower mean counts of aerobes than before patient arrival or before cleaning and disinfection (Fig. 1). The mean CFUs of MRSA per Rodac plate (CFU/25 cm2) were 0.04 before patient arrival, 0.66 before cleaning and disinfection, and 0.08 after cleaning and disinfection (P = .0006, after cleaning and disinfection vs before cleaning and disinfection). Of environmental sites where MRSA was identified, 87.2% were on floors (41 of 47) and 19.1% were after cleaning and disinfection (9 of 47, 8 from floors and 1 from pyxis touchscreen). The A2/B2 MRSA strain was identified on different environmental sites (eg, floor, computer desk, counter) in various rooms (eg, OR2, OR10, and OR16), even after cleaning and disinfection (Fig. 2). Conclusions: Our study has demonstrated that the OR environment was contaminated with aerobic bacteria and MRSA after surgery and that MRSA persisted in the environment even after cleaning and disinfection. Enhanced environmental cleaning in the perioperative environment used for patients on isolation is necessary to prevent transmission of healthcare-associated pathogens in ORs.Funding: NoneDisclosures: Drs. Rutala and Weber are consultants to PDI (Professional Disposable International)

Variability of Contact Precaution Policies in US Emergency Departments

2014 ◽  
Vol 35 (3) ◽  
pp. 310-312 ◽  
Author(s):  
Daniel J. Pallin ◽  
Carlos A. Camargo ◽  
Deborah S. Yokoe ◽  
Janice A. Espinola ◽  
Jeremiah D. Schuur
Keyword(s):  
Emergency Medicine ◽  
Staphylococcus Aureus ◽  
Clostridium Difficile ◽  
Random Sample ◽  
Emergency Departments ◽  
Contact Precaution ◽  
Methicillin Resistant ◽  
Contact Precautions ◽  
Stool Incontinence

Contact precautions policies in US emergency departments have not been studied. We surveyed a structured random sample and found wide variation; for example, 45% required contact precautions for stool incontinence or diarrhea, 84% for suspected Clostridium difficile, and 79% for suspected methicillin-resistant Staphylococcus aureus infection. Emergency medicine departments and organizations should enact policies.

Lack of Benefit With Combination Therapy for Clostridium difficile Infection

2017 ◽  
Vol 38 (5) ◽  
pp. 602-605
Author(s):  
Jessica C. Njoku ◽  
Trevor C. Van Schooneveld ◽  
Mark E. Rupp ◽  
Keith M. Olsen ◽  
Fang Qiu ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Combination Therapy ◽  
Confidence Interval ◽  
Clinical Outcomes ◽  
Clostridium Difficile Infection ◽  
Infect Control Hosp ◽  
Limited Data ◽  
Duration Of Therapy ◽  
Prolonged Duration

Limited data exist regarding combination therapy for Clostridium difficile infection (CDI). After adjusting for confounders in a cohort of patients with CDI and≥1 year old, combination therapy was not associated with significant differences in clinical outcomes, but it was associated with prolonged duration of therapy (1.22 days; 95% confidence interval, 1.03–1.44 days; P=.02).Infect Control Hosp Epidemiol 2017;38:602–605

scholarly journals 3442 Among Hospitalized Patients, Cannabis use is Associated with Reduced risk of Clostridium Difficile infection

2019 ◽  
Vol 3 (s1) ◽  
pp. 33-34
Author(s):  
Adeyinka Charles Adejumo ◽  
Terence Ndonyi Bukong
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Hospitalized Patients ◽  
Cannabis Use ◽  
Care Utilization ◽  
P Value ◽  
Adjusted Relative Risk ◽  
Increased Risk ◽  
The Impact ◽  
Reduced Risk

OBJECTIVES/SPECIFIC AIMS: Clostridium Difficile Infection (CDI), a prevalent cause of diarrhea, is the most notorious hospital-acquired infection, resulting in an alarming mortality and health care utilization rates. Herein, we investigate the impact of cannabis use, which is gaining significant legalization for recreational use, on the risk of CDI. METHODS/STUDY POPULATION: We selected adult records (age ≥ 18 years) from the Nationwide Inpatient Sample 2014, and identified cannabis users and other clinical conditions using ICD-9-CM codes. With multivariate logistic modeling, we generated propensity scores for cannabis users and matched them to non-users in a 1:1 ratio (104,936:104,936). We then estimated the adjusted relative risk (aRR) for having CDI using conditional Possion regression models with generalized estimating equations [SAS 9.4]. RESULTS/ANTICIPATED RESULTS: Among the matched hospitalizations (n=209,872), cannabis usage was associated with a reduced incidence of CDI (505.8[464.7-550.6] vs. 694.9[645.8-747.70] per 100,000 hospitalizations), resulting in a 27% reduced risk of CDI (aRR:0.73[0.65-0.81]; p-value:<0.0001). Non-dependent and dependent cannabis users respectively had 22% and 78% reduced likelihood of CDI when compared to non-cannabis users (0.78[0.69-0.90] & 0.22[0.12-0.40]). Furthermore, dependent users had less risk of CDI compared to non-dependent users (0.28[0.16-0.51]). Comparatively, abusive use of other substances like alcohol and tobacco was associated with increased risk for CDI (1.30[1.13-1.49] & 1.24[1.10-1.40]) DISCUSSION/SIGNIFICANCE OF IMPACT: Unlike alcohol and tobacco abuse which are associated with elevated risk for CDI, cannabis use, is related to a decreased risk of CDI amongst hospitalized patients. Further prospective and molecular mechanistic studies are required to elucidate how cannabis impacts CDI.

scholarly journals 2025. Evaluation of the Impact of an Antimicrobial Stewardship Program in a Tertiary Hospital in Northern Italy: Efficacy of a Persuasive Approach on Antibiotics Consumption and Rate of Clostridium difficile Infection

2019 ◽  
Vol 6 (Supplement_2) ◽  
pp. S679-S680
Author(s):  
Erika Chiari ◽  
Davide Mangioni ◽  
Ester Pollastri ◽  
Liana Signorini ◽  
Giovanni Moioli ◽  
...  
Keyword(s):  
Clostridium Difficile ◽  
Clostridium Difficile Infection ◽  
Antimicrobial Stewardship ◽  
Positive Impact ◽  
Epidemiological Data ◽  
Tertiary Hospital ◽  
Northern Italy ◽  
Stewardship Program ◽  
Bed Days ◽  
The Impact

Abstract Background Antimicrobial resistance (AMR) situation in Italian hospitals and regions represents a major public health threat [ECDC, 2017]. Antimicrobial stewardship programs (ASPs), particularly when based on local epidemiology, have been beneficial in optimizing antibiotic therapy as well as reducing hospital rates of Clostridium difficile infection (CDI) and AMR [Akpan MR, Antibiotics 2016].. Methods Our ASP program has been conducted at Spedali Civili General Hospital of Brescia, Northern Italy (1300-bed tertiary hospital), between the beginning of 2016 and the end of 2017. A preliminary analysis of local epidemiological data was performed (Table 1). Seven groups (“districts”) were identified according to microbiological and clinical similarities. This was a persuasive-based ASP. First, we trained physicians on general principles of AS, then guidelines for the management of “difficult-to-handle” infections were drafted based on international guidelines and local microbiological data (Table 2).. Results Here we show the results of pre-ASP (2015) vs. post-ASP (2018) analysis on antibiotic consumption (AC) and CDI rates. AC is expressed in DDD/100 bed-days. The overall hospital AC decreased from 84.31 to 76.84 (−9%), consistently with national recommendations [Italian National Plan against AMR, 2017]. In accordance with the local guidelines developed within our ASP, carbapenem consumption decreased from 5.77 to 4.87 (−16%) and fluoroquinolones (FLQ) from 14.45 to 9.94 (−31%). At the same time piperacillin/tazobactam use increased from 5.53 to 8.46 (53%). 3°–4°G cephalosporins and glycopeptides consumption slightly reduced from 11.78 to 11.42 (−3%) and from 4.07 to 3.83 (−6%), respectively. AC of the different districts involved is reported in Table 3. CDI rates decreased from 0.0434/100 bed-days in 2015 to 0.0315/100 bed-days in 2018 (−27%) (Figure 1). Conclusion Our ASP was a persuasive-based program in a setting of high AMR rates. In the short term, it has shown a positive impact in improving AC (in particular of broad-spectrum antibiotics with a high risk of resistance selection and CDI) and CDI rates. Audits for local guidelines adherence and the evaluation of AC, AMR and CDI rates are ongoing as long-term quality measures for assessing the impact of our ASP. Disclosures All authors: No reported disclosures.

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