Impact of COVID-19 prevention measures on risk of health care-associated Clostridium difficile infection
- •Many strategies to reduce microorganism spread were adopted during the COVID-19 pandemic.
- •We have retrospectively analyzed the period of the pandemic and previous years.
- •Such strategies reduce healthcare-associated (HA) C difficile infection (HA-CDI) incidence.
- •Maintaining these measures over time could reduce HA-CDI and related expenses.
- •This study helps to understand effective hygiene interventions to prevent CDI.
Clostridium difficile is the most common pathogen between healthcare-associated infections and its incidence has increased during the last years. lack of enough evidence about effective hygiene interventions to prevent this disease. Due to the coronavirus disease 2019 (COVID‑19) pandemic, several strategies to reduce microorganism spread were adopted in a hospital setting. The objective of this study was to establish whether such strategies can reduce healthcare-associated C difficile infection (HA-CDI) incidence. We found that during the pandemic (2020) HA-CDI incidence was significantly lower with respect to the previous years. This work demonstrates that maintaining this level of attention regarding control activities related to the prevention of microorganism transmission significantly reduces HA-CDI and related expenses in terms of health costs and human lives.
(CD) is the most common pathogen among healthcare-associated (HA) infections.
An important obstacle in the prevention of C difficile infection (CDI) is the lack of enough evidence about effective hygiene interventions to prevent this disease. Although preventive contact precautions are recommended, there is no sufficient data on their effectiveness for its prevention.
Due to the coronavirus disease 2019 (COVID-19) pandemic, several strategies to reduce microorganism spread were adopted in a hospital setting.
The objective of this study was to establish whether such strategies can reduce HA-CDI incidence. The primary task was to identify differences in HA-CDI incidence in medical wards before and during the COVID-19 pandemic. The secondary task was to evaluate if severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection could influence the incidence of CDI.
We conducted a retrospective analysis on medical wards’ discharges (n. 1617) in S. Andrea Hospital (Rome) from March 1 to June 30, 2020, comparing data before (2017, 2018, and 2019) and during (2020) the COVID-19 pandemic. Intensive care units and paediatric wards were excluded. CDI diagnosis was confirmed by clinical suspicious (presence of diarrhea defined as ≥3 unformed stools in 24 hours) plus stool tests positive for CD. HA-CDI incidence was depicted as CDI diagnosed ≥72 hours after admission per 100 total discharges. Data was collected using Excel Office, and χ² test was performed to detect differences in HA-CDI incidence between different groups. Value of P< .05 was considered significant.
The number of discharges and HA-CDI diagnosis for each medical ward is reported in Table 1
. No statistically significant difference of HA-CDI incidence between the years 2017, 2018, and 2019 was observed. Conversely, during the pandemic (2020) HA-CDI incidence was significantly lower with respect to 2017 (odds ratio [OR] = 2.98; P
= .002), 2018 (OR = 2.27; P =
and 2019 (OR = 2.07; P
= .047) (see Table 1
and Fig. 1
). Interestingly, during 2020, COVID-19 departments showed higher HA-CDI incidence respect to Covid-19 free wards (not significative). This data suggests SARS-Cov2 infection as a possible risk factor for CDI in agreement with recent evidences that report altered gut microbiota in COVID-19 patients.
Furthers studies are needed to confirm this hypothesis.
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