Category Archives: C. diff. prevention

Proton-Pump Inhibitors and Increased Risk of C. diff. Infections

 

 

 

 

 

Increased risk for Clostridium difficile (C diff) infection remained elevated for up to a year after the conclusion of treatment with proton-pump inhibitors (PPIs), according to a paper published in Clinical Infectious Diseases.

Malin Inghammar, PhD

Source and to read the article in its entirety please click on the following link to be redirected:

https://www.hcplive.com/view/elevated-risk-c-diff-proton-pump-inhibitor-use

Investigators from Copenhagen, Denmark used a nationwide cohort of adults with
a C diff infection in order to compare periods with and without exposure to PPIs. The adults were all treated between February 2010 and December 2013. The nationwide database included health information such as C diff testing, filled prescriptions, and patient characteristics. The investigators also accounted for the previous hospitalization in the previous 12 weeks in the patients, in addition to chronic disease, genetics, socioeconomic status, length of hospital stay, and antibiotic and corticosteroid use.

Ultimately, the study authors identified 3583 episodes of community-acquired C diff infection, of which 964 occurred during the current use of PPIs. This is an observation in the current literature, but what wasn’t understood was the full extent of the relationship due to missing data from randomized controlled trials, variability between studies, and insufficient adjustment for confounding.

“While a history of prior hospital admission, advanced age, and antibiotic use are well-known risk factors for C diff infection, the role of PPIs has remained controversial,” the study authors wrote.

The investigators defined new PPI use as a new prescription for individuals who had not used PPI in the prior 365 days. They split up the periods of 0-6 months and 6-12 months because in the first period, cessation was considered indeterminate use because of the possibility for intermittent use or drug exposure continuing beyond the use period. Exposure during the 6-12 month period was “unlikely.”

Of the infections that occurred with the use of PPIs, 324 occurred within 0-6 months after treatment conclusion. Additionally, 123 cases occurred between 6 and 12 months after treatment cessation.

The remainder of C diff infection cases occurred during time periods without use of PPIs, the investigators said.

Comparing the use of PPIs with nonuse, the study authors found that the adjusted estimate incidence rate ratio (IRR) was 2.03, they said. But the risk remained elevated in later time periods too: 1.54 for 0-6 months and 1.24 for 6-12 months.

“In conclusion, in this nationwide study in Denmark, we showed that exposure to PPIs was associated with a moderate increase in the risk of community-acquired C diff infection,” the study authors said while noting that the mechanism by which PPIs may increase the C diff infection risk remains unclear. “The increased risk was most prominent during current PPI use but also persisted after treatment discontinuation.”

One limitation the study authors provided for was that initial symptoms of C diff infection could have been misinterpreted and patients prescribed PPIs could not be excluded. But, they also admitted, “it is unlikely that this would lead to biased results because the symptoms of C diff infection (diarrhea) are distinct from the upper gastrointestinal symptoms that represent the most common indication for PPIs.”

Researchers Find Infection Prevention Cleaning Compliance to Be More Effective In Reducing the Spread of C. diff.

Small changes in daily hygiene are more effective than visitor contact precautions in preventing C. difficile (C. diff.) among elderly patients in long-term care centers, according to a new study published in JAMA Network Open.

Researchers at the University of Wisconsin in Madison, Wisconsin, studied infection control regimens to deter C. diff transmission in a 200-bed acute care adult hospital. Visitor contract precautions (VCPs) are a common regimen, in which visitors don gowns and gloves when entering the room of a patient with a C. diff infection (CDI).

Implementing VCPs requires considerable worker and personal protective equipment (PPE) resources. In addition, VCPs are often associated with adverse effects for patients, as they limit the amount of visitors patients may see and often lead to increased delirium and depression.

After researchers accounted for factors such as patient susceptibility, behavior, and transmission, they found VCPs resulted in minimal change, contributing to a 1% or less decrease in infection rate.

Investigators seeking a better method of containing CDI looked at the effects of stressing health care worker’s hand hygiene, daily cleaning of patient rooms and common areas, as well as thorough terminal cleaning of rooms between patients. They determined that slightly increasing worker hand hygiene and environmental cleaning compliance— by no more than 2%— were associated with larger infection decreases.

 

 

 

 

 

 

Source:  https://www.cmmonline.com/news/learn-how-the-cleaning-industry-can-help-with-updated-cdc-travel-guidelines

Study Finds COVID-19 Cleaning Protocols Decreased C. diff. Infections In 2020 Compared To the Past Three Years

 

Protocols enacted by hospital environmental services (EVS) staff and healthcare workers to prevent the spread of the SARS-CoV-2 virus have also been effective against another infectious disease—Clostridium. difficile (C. diff).

 

study in the American Journal of Infection Control found that the incidence of C. diff substantially decreased in 2020 compared to the previous three years due to steps taken to reduce COVID-19 infection, specifically greater attention to hand hygiene, the use of masks, and the proper donning and doffing of personal protective equipment (PPE).

Researchers with Sant’Andrea University Hospital of Rome in Italy compared data on people discharged from the hospital from March 1 to June 30, 2020, to discharge data from 2017, 2018, and 2019. While the investigators found that there was no statistically significant difference in   C. diff incidence in 2017, 2018, and 2019, the 2020 results proved to be quite different.

In 2017, among 422 discharged patients, 39 were found to have C. diff. In 2018, 25 patients from 348 discharged had C. diff and in 2019, 24 patients from 364 discharged had C. diff.

In comparison, only 11 patients among 333 discharged from wards without COVID-19 patients in 2020 had C. diff and seven patients from 150 patients discharged from COVID-19 wards had C. diff.

Investigators could not determine which of the pandemic protocols played the biggest role in slowing C. diff spread, but they noted that previous studies have shown that hand hygiene alone wasn’t enough.

Interestingly, COVID-19 wards showed a higher incidence of C. diff, which suggests coronavirus infection as a possible risk factor for C. diff.

C. diff is the most common pathogen among healthcare-acquired infections (HAIs). Learn cleaning best practices to prevent HAIs in health care facilities.

Who Are Infection Preventionists and Learn Why These Healthcare Professionals Are So Important

October 18th – 24th We Celebrate Infection Preventionists Worldwide.

Who Are Infection Preventionists?

Infection Preventionists (IPs) keep patients and healthcare workers safe from healthcare-associated infections (HAIs).

Take a minute to view the following video to help understand how IPs help improve patient care and safety, especially during the COVID-19 pandemic.

THANK YOU IP’S ~ We Salute Your Efforts And Dedication!

 

Infection Preventionists Save Lives

 

For Additional Information please visit the APIC website

www.apic.org

Researchers Evaluate Healthcare-Onset and Healthcare-Facility-Associated C. difficile Infections

 

Authors:
Dipesh Solanky12Derek K Juang#12Scott T Johns#3Ian C Drobish12Sanjay R Mehta124Monika Kumaraswamy1245

Abstract

Objective: Lack of judicious testing can result in the incorrect diagnosis of Clostridioides difficile infection (CDI), unnecessary CDI treatment, increased costs, and falsely augmented hospital-acquired infection (HAI) rates. We evaluated facility-wide interventions used at the VA San Diego Healthcare System (VASDHS) to reduce healthcare-onset, healthcare-facility-associated CDI (HO-HCFA CDI), including the use of diagnostic stewardship with test ordering criteria.

Design: We conducted a retrospective study to assess the effectiveness of measures implemented to reduce the rate of HO-HCFA CDI at the VASDHS from fiscal year (FY)2015 to FY2018.

Interventions: Measures executed in a stepwise fashion included a hand hygiene initiative, prompt isolation of CDI patients, enhanced terminal room cleaning, reduction of fluoroquinolone and proton-pump inhibitor use, laboratory rejection of solid stool samples, and lastly diagnostic stewardship with C. difficile toxin B gene nucleic acid amplification testing (NAAT) criteria instituted in FY2018.

Results: From FY2015 to FY2018, 127 cases of HO-HCFA CDI were identified. All rate-reducing initiatives resulted in decreased HO-HCFA cases (from 44 to 13; P ≤ .05). However, the number of HO-HCFA cases (34 to 13; P ≤ .05), potential false-positive testing associated with colonization and laxative use (from 11 to 4), hospital days (from 596 to 332), CDI-related hospitalization costs (from $2,780,681 to $1,534,190) and treatment cost (from $7,158 vs $1,476) decreased substantially following the introduction of diagnostic stewardship with test criteria from FY2017 to FY2018.

Conclusions: Initiatives to decrease the risk for CDI and diagnostic stewardship of C. difficile stool NAAT significantly reduced HO-HCFA CDI rates, detection of potential false-positives associated with laxative use, and lowered healthcare costs. Diagnostic stewardship itself had the most dramatic impact on outcomes observed and served as an effective tool in reducing HO-HCFA CDI rates.

 

 

 

 

To view the article in its entirety please click on the link below to be redirected. Thank You.

https://pubmed.ncbi.nlm.nih.gov/32943129/