Clostridium difficile infections that develop in hospitals are often due to both environmental and patient risk factors.
Improved environmental conditions and private hospitals rooms could reduce hospital-onset ratesclostridium difficileAccording to a study published online by theAmerican Journal of Infection Control. The authors used a segmented regression model to analyze trends in quarterly CDI incidences before and after patients were moved to a new hospital. The model also included the timing of the relocation.
Researchers at Okayama Saiseikai General Hospital in Okayama City (Japan) were evaluating risk factors and noticed a shift in hospital-onset CDI incidence after patients were moved to a new hospital with 50% private rooms. They explained that hospital-onset CDI is often caused by both environmental and patient risk factors.
Researchers also used a linear regression analysis model to evaluate the relationship between CDI incidence and environmental factors at ward-level. The study was performed between January 1, 2013, to June 30, 2019, which was 3 and 3.5 years prior to the hospital relocation.
Patients in the study were initially treated at OSGH, before being transferred to a nearby hospital on January 1, 2016. OSGH is a hospital for acute care with 553 beds and 15 department. About 50% of patients are admitted for gastrointestinal, biliary and pancreatic diseases.
During the course of the study, the researchers observed environmental conditions and cleanliness in patient rooms. The hospital was observed to have a specific protocol in place for CDI prevention. These included recommendations for handwashing patients and individuals who come into contact with infected persons, as well protective gear, disinfectant and quarantines.
Investigators found 322 hospital-onset CDI in 524,475 OSGH patient-days over the 3-year period. This compares with 62 infections in 531,697 new hospital patient-days over the 3.5 year period. The incidence of hospital-onset CDI decreased from 6.14 to 1.17 for every 10,000 patient-days in OSGH compared with new hospitals. The community-onset CDI incidence rate fell from 1.71 to 0.46 for 1000 admissions.
The researchers did not observe any downward trend prior to the move (Coef. 0.005, 95%CI, -0.053 to 0.063,P= 0.85; however, there was a significant downtrend after relocation (Coef. -0.111, 95%CI, -0.185 to-0.038P =0.006) because the number of cases dropped 11% every 3 month.
Researchers used a Poisson regression to calculate an IRR 0.19 (95%CI 0.15 to 0.25).P0.001) during the time of hospital move. This represents an 81% reduction in hospital-onset CDI, which was not transient and continued for at most 3.5 years after the relocation.
There was a positive correlation between hospital-onset CDI incidence and community-onset CDI incidence. However, this was inversely related to the private room ratio (adjustedR2= 0.83). Additionally, about half of patients with community-onset CDI were admitted within 28 days of their onset.
The Poisson regression analysis revealed that the incidence rate ratio was 0.27 (95%CI, 0.16 to 0.44).P0.001) at the time of hospital relocate and there were no significant downtrends before relocation (Coef. -0.006, 95%CI, -0.086 to 0.033,P= 0.87). Researchers also found that the incidence of community-onset CDI was the most reliable predictor of hospital-onset CDI. Each 1000-days of community admissions was associated with an increase of 2.1 hospital-onset infections (= 0.87).P<0.001, R2=0.73).
Relocation might have led to environmental improvements that may have helped reduce the reservoir.C. difficileThis has led to a decrease of asymptomatic carriers. [community-onset]The study authors wrote that CDI patients were significantly less likely to be relocated to a new hospital. The relocation to a new hospital has a significant reduction in cost [hospital-onset]CDI incidence decreases the incidence of [community-onset]CDI could be due to environmental improvements
Refer to
Shiode J., et all. Correlation between community-onset and hospital-onsetClostridioides difficileAfter hospital relocation, ward-level analysis of infection incidence American Journal of Infection Control. Online. https://www.sciencedirect.com/science/article/pii/S0196655322000748. Published February 12, 2022. Accessed February 21, 2022.
