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Research Study Finds Patient Age, Use of Proton Pump Inhibitors and the Administration of Primary Prophylaxis Were Not Significant Predictors of Hospital-Onset C.diff. Infection

Increasing length of stay, exposure to multiple classes of antibiotics, use of opioids and cirrhosis are all independently associated with an increased risk for hospital-onset Clostridioides difficile infection, or CDI, in asymptomatic colonized patients, but age is not, according to findings from a retrospective cohort study.

According to Yves Longtin, MD, chair of infection prevention and control at Jewish General Hospital in Montreal and associate professor of medicine at McGill University, and colleagues, “colonized individuals are at risk of progressing to CDI, but the factors that trigger progression to CDI are poorly understood.”

For their study, Longtin and colleagues assessed 513 patients colonized with C. difficile at the Quebec Heart and Lung Institute between November 2013 and January 2017, 7.6% of whom developed hospital-onset CDI. The 30-day attributable mortality was 15%.

The researchers found that hospital-onset CDI was independently associated with an increased length of stay (adjusted OR per day = 1.03; P = .006), exposure to multiple classes of antibiotics (aOR per class = 1.45; P = .02), use of opioids (aOR = 2.78; P = .007) and cirrhosis (aOR = 5.49; P = .008).

The use of laxatives was associated with a lower risk for CDI (aOR = 0.36; P = .01), according to the findings.

Longtin and colleagues also assessed the impact of specific antibiotics on CDI risk and found that beta-lactam with beta-lactamase inhibitors (OR = 3.65; P < .001), first-generation cephalosporins (OR = 2.38; P = .03) and carbapenems (OR = 2.44; P = .03) demonstrated the greatest risk for hospital-onset CDI.

Patient age, use of proton pump inhibitors and the administration of primary prophylaxis were not significant predictors of hospital-onset CDI, the researchers said.

“The lack of association between age and the risk of CDI among colonized patients is striking considering that age is among the strongest predictors for CDI,” Longtin and colleagues wrote. “This finding suggests that age may be associated with an increased risk of CDI through a greater susceptibility to colonization rather than an increased risk of progression to CDI once colonization has occurred, although studies on this topic have produced conflicting results.”

Although the findings demonstrated several predictive factors associated with hospital-onset CDI among colonized patients, Poirier and colleagues noted that further investigation is needed to determine whether “modifying these variables could decrease the risk of CDI.” – Marley Ghizzone




Disclosures: Longtin reports receiving research funding from Becton Dickinson and Merck, and research funding and personal fees from Gojo. Please see the study for all other authors’ relevant financial disclosures

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Hand-Washing aka Hand Hygiene Patient Education Proves Successful To Reduce C.diff. Infections

HandHygiene #1 Prevention

Hand-Washing aka hand hygiene Remains #1 In Infection Prevention In Every Setting.

“Despite evidence to suggest that [hand hygiene] is important in preventing infection, hospitalized patients are often not provided the opportunity to clean their hands,” due to mobility and cognitive obstacles as well as lack of education, investigators wrote.

Education on patient hand hygiene significantly reduced the incidence of Clostridium difficile infection at University of Pittsburgh Medical Center Mercy Hospital.

First, they conducted baseline surveys to assess patient hand hygiene, which showed patients needed more opportunities to wash their hands. Then nurse educators provided staff with an educational presentation on the importance of patient hand hygiene for preventing infection, which included specific times they should encourage and assist patients with hand hygiene. Staff then provided education and assistance to newly admitted patients, and researchers conducted additional surveys after implementation of this intervention.

During the first phase of the study involving just four medical-surgical nursing units, patient hand hygiene education increased significantly after the intervention (P < .0001). Overall, 97 follow-up surveys showed the proportion of those who received hand hygiene education increased from 34% to 64%, the opportunities provided for hand hygiene increased from 60% to 86%, and the average number of times hand hygiene was performed daily increased from 2.7 to 3.75.

After expanding the intervention to the whole hospital in the second phase of the study, 189 follow-up surveys showed that patient hand hygiene education increased from 48% to 53%. Meanwhile, overall opportunities for hand hygiene remained unchanged from 68%, and daily frequency of patient hand hygiene did not change significantly (mean, 2.4 vs. 2.6 times per day).

Notably, CDI rates dropped significantly during the 6 months following hospital-wide implementation.

“[Standardized infection ratio] P values for Q2 and W3 (0.0157 and 0.0103, respectively) were significantly lower than expected (P .05),” investigators wrote. “The Q4 SIR, however, showed an increase to 0.3844 over the 2 preceding quarters.”

They concluded that these findings showed patient hand hygiene “should be considered a potential addition to CDI prevention measures in hospitalized patients.” – by Adam Leitenberger

Source:  https://www.healio.com/gastroenterology/infection/news/online/%7B0ea95c50-ddec-4259-a229-5979fde9d8af%7D/patient-handwashing-cuts-c-difficile-rate-in-hospital