Keywords
Hospital outbreak
Infection control
Clostridioides difficile
Toxin B
Infection control
Clostridioides difficile
Toxin B
Abstract
Objective. To describe the outbreak of Clostridioides difficile infection (CDI), and the impact of the prevention and control measures that were implemented in the “Hospital Juárez de México” (HJM) for its control. Study design. A cross-sectional, descriptive, observational, and retrospective study was designed. Methods. Information on the hospital outbreak and on health care-associated infections (HCAI) was obtained from the files of the Hospital Epidemiological Surveillance Unit (HESU) of the HJM. Results. A total of 15 cases of CDI were detected from February 20th to May 22nd, 2018, which represented 55.6% and 44.4% for the male and female gender, respectively, with an average age of 56 years and a range of 24 to 86 years old. It was possible to identify six failures and deficiencies that involved health personnel and hospital logistics through analyses based on the situational diagnosis in the services involved and through the construction of cause-effect diagrams. Additionally, through the detection of the outbreak by means of laboratory tests and timeline, the HESU team implemented measures and prospective surveillance to control and prevent the emergence of new cases. Conclusions. The implementation of basic quality tools, control measures, and the prospective epidemiological surveillance had a positive impact on the control against the outbreak of C. difficile producing toxin B.
References
1. Leffler DA, Lamont JT. Clostridium difficile infection. N Engl J Med. 2015 Apr 16;372(16):1539-48.
2. Sosa-Hernández O, Alarcón-Hernández GP, Matías-Téllez B, Cureño-Díaz MA. Clostridium difficile: cambio de paradigmas en la epidemiología hospitalaria y el control de infecciones. Rev Hosp Jua Mex. 2018; 85(1): p. 39-44.
3. Aktories K, Schwan C, Jank T. Clostridium difficile Toxin Biology. Annu Rev Microbiol. 2017 Sep 8;71:281-307. Epub 2017 Jun 28.
4. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Society Healthcare Epidemiology of America / Infectious Diseases Society of America. Guía de práctica clínica para la infección por Clostridium difficile en adultos: actualización 2010 realizada por la Sociedad de Salud Epidemiológica de Norteamérica (SHEA) y la Sociedad de Enfermedades Infecciosas de Norteamérica (IDSA). Infect Control Hosp Epidemiol 2010; 31(5):TI–T28.
5. He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013 Jan;45(1):109-13.
6. Dávila LP, Garza-González E, Rodríguez-Zulueta P, Morfín-Otero R, Rodríguez-Noriega E, Vilar-Compte D, et al. Increasing rates of Clostridium difficile infection in Mexican hospitals. Braz J Infect Dis. 2017 Sep - Oct;21(5):530-534.
7. Martínez-Rodríguez A, Estrada-Hernández L, Tomé-Sandoval P, Salazar-Salinas J. Diarrea por Clostridium difficile en pacientes hospitalizados. Med Int Méx. 2018 enero; 34(1): 9-18.
8. Velarde Ruiz-Velasco JA, Aldana-Ledesma JM, Ibarra-Estrada MA, Aguirre-Díaz SA, Fernández-Ramírez JA, Cárdenas-Lara F, et al. Características clínicas y endoscópicas en diarrea hospitalaria asociada a infección por Clostridium difficile. Revista de Gastroenterología de México. 2017; 82(4): p. 301-308.
9. Tamez-Torres KM, Torres-González P, Leal-Vega F, García-Alderete A, López García NI, Mendoza-Aguilar R, et al. Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center. Int J Infect Dis. 2017 Dec;65:44-49.
10. Martínez-Rodríguez A, Estrada-Hernández L, Tomé-Sandoval P, Salazar-Salinas J. Diarrea por Clostridium difficile en pacientes hospitalizados. Med Int Méx. 2018 enero; 34(1): p. 9-18.
11. Spagnolo AM, Sartini M, Battistella A, Casini B, Lo Pinto G, Schinca E, et al. A Clostridium difficile outbreak in an Italian hospital: the efficacy of the multi-disciplinary and multifaceted approach. J Prev Med Hyg. 2018 Jun 1;59(2):E132-E138.
12. Rutala WA, Weber DJ, HICPAC. Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008. Last update: Feburary 15, 2017.
13. Sosa-Hernández O, Gorordo-Delsol LA. Importancia de la higiene de manos para prevenir la sepsis en la atención de la salud. Med Crit. 2018; 32(5): 295.296.
14. Assanta MA, Massicotte R, Pichette G, Ahmad D. Importance of mechanical action in a terminal disinfection process for decontamination of Clostridium difficile spores on hospital inert contact surfaces. Int J Infect Control. 2014; 11(13).
15. Ng Wong YK, Alhmidi H, Mana TSC, Cadnum JL, Jencson AL, Donskey CJ. Impact of routine use of a spray formulation of bleach on Clostridium difficile spore contamination in non-C difficile infection rooms. Am J Infect Control. 2019 Jan 31. pii: S0196-6553(18)31205-7.
16. Weber DJ, Kanamori H, Rutala WA. 'No touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Opin Infect Dis. 2016 Aug;29(4):424-31.
17. Best EL, Parnell P, Thirkell G, Verity P, Copland M, Else P, et al. Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high Clostridium difficile infection incidence. J Hosp Infect. 2014 May;87(1):25-33.
18. Kenters N, Huijskens EGW, de Wit SCJ, Sanders IGJM, van Rosmalen J, Kuijper EJ, et al. Effectiveness of various cleaning and disinfectant products on Clostridium difficile spores of PCR ribotypes 010, 014 and 027. Antimicrob Resist Infect Control. 2017 Jun 3;6:54.
19. Steindl G, Fiedler A, Huhulescu S, Wewalka G, Allerberger F. Effect of airborne hydrogen peroxide on spores of Clostridium difficile. Wien Klin Wochenschr. 2015 Jun;127(11-12):421-6.
20. Horn K, Otter JA. Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase. Am J Infect Control. 2015 December; 43(12): p. 1354 - 1356.
21. Mosci D, Marmo GW, Sciolino L, Zaccaro C, Antonellini R, Accogli L, et al. Automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial. J Hosp Infect. 2017 Oct;97(2):175-179.
22. McCord J, Prewitt M, Dyakova E, Mookerjee S, Otter JA. Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection. J Hosp Infect. 2016 Oct;94(2):185-7.
23. Krutova M, Kinross P, Barbut F, Hajdu A, Wilcox MH, Kuijper EJ, et al. How to: Surveillance of Clostridium difficile infections. Clin Microbiol Infect. 2018 May;24(5):469-475.
24. van Beurden YH, Bomers MK, van de Werff SD, Pompe EAPM, Spiering S, Vandenbroucke-Grauls CMJE, et al. Cost analysis of an outbreak of Clostridium difficile infeciton ribotype 027 in a Dutch tertiary care centre. J Hospl Infect. 2017 April; 95(4).
2. Sosa-Hernández O, Alarcón-Hernández GP, Matías-Téllez B, Cureño-Díaz MA. Clostridium difficile: cambio de paradigmas en la epidemiología hospitalaria y el control de infecciones. Rev Hosp Jua Mex. 2018; 85(1): p. 39-44.
3. Aktories K, Schwan C, Jank T. Clostridium difficile Toxin Biology. Annu Rev Microbiol. 2017 Sep 8;71:281-307. Epub 2017 Jun 28.
4. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, et al. Society Healthcare Epidemiology of America / Infectious Diseases Society of America. Guía de práctica clínica para la infección por Clostridium difficile en adultos: actualización 2010 realizada por la Sociedad de Salud Epidemiológica de Norteamérica (SHEA) y la Sociedad de Enfermedades Infecciosas de Norteamérica (IDSA). Infect Control Hosp Epidemiol 2010; 31(5):TI–T28.
5. He M, Miyajima F, Roberts P, Ellison L, Pickard DJ, Martin MJ, et al. Emergence and global spread of epidemic healthcare-associated Clostridium difficile. Nat Genet. 2013 Jan;45(1):109-13.
6. Dávila LP, Garza-González E, Rodríguez-Zulueta P, Morfín-Otero R, Rodríguez-Noriega E, Vilar-Compte D, et al. Increasing rates of Clostridium difficile infection in Mexican hospitals. Braz J Infect Dis. 2017 Sep - Oct;21(5):530-534.
7. Martínez-Rodríguez A, Estrada-Hernández L, Tomé-Sandoval P, Salazar-Salinas J. Diarrea por Clostridium difficile en pacientes hospitalizados. Med Int Méx. 2018 enero; 34(1): 9-18.
8. Velarde Ruiz-Velasco JA, Aldana-Ledesma JM, Ibarra-Estrada MA, Aguirre-Díaz SA, Fernández-Ramírez JA, Cárdenas-Lara F, et al. Características clínicas y endoscópicas en diarrea hospitalaria asociada a infección por Clostridium difficile. Revista de Gastroenterología de México. 2017; 82(4): p. 301-308.
9. Tamez-Torres KM, Torres-González P, Leal-Vega F, García-Alderete A, López García NI, Mendoza-Aguilar R, et al. Impact of Clostridium difficile infection caused by the NAP1/RT027 strain on severity and recurrence during an outbreak and transition to endemicity in a Mexican tertiary care center. Int J Infect Dis. 2017 Dec;65:44-49.
10. Martínez-Rodríguez A, Estrada-Hernández L, Tomé-Sandoval P, Salazar-Salinas J. Diarrea por Clostridium difficile en pacientes hospitalizados. Med Int Méx. 2018 enero; 34(1): p. 9-18.
11. Spagnolo AM, Sartini M, Battistella A, Casini B, Lo Pinto G, Schinca E, et al. A Clostridium difficile outbreak in an Italian hospital: the efficacy of the multi-disciplinary and multifaceted approach. J Prev Med Hyg. 2018 Jun 1;59(2):E132-E138.
12. Rutala WA, Weber DJ, HICPAC. Guideline for Disinfection and Sterilization in Healthcare Facilities. 2008. Last update: Feburary 15, 2017.
13. Sosa-Hernández O, Gorordo-Delsol LA. Importancia de la higiene de manos para prevenir la sepsis en la atención de la salud. Med Crit. 2018; 32(5): 295.296.
14. Assanta MA, Massicotte R, Pichette G, Ahmad D. Importance of mechanical action in a terminal disinfection process for decontamination of Clostridium difficile spores on hospital inert contact surfaces. Int J Infect Control. 2014; 11(13).
15. Ng Wong YK, Alhmidi H, Mana TSC, Cadnum JL, Jencson AL, Donskey CJ. Impact of routine use of a spray formulation of bleach on Clostridium difficile spore contamination in non-C difficile infection rooms. Am J Infect Control. 2019 Jan 31. pii: S0196-6553(18)31205-7.
16. Weber DJ, Kanamori H, Rutala WA. 'No touch' technologies for environmental decontamination: focus on ultraviolet devices and hydrogen peroxide systems. Curr Opin Infect Dis. 2016 Aug;29(4):424-31.
17. Best EL, Parnell P, Thirkell G, Verity P, Copland M, Else P, et al. Effectiveness of deep cleaning followed by hydrogen peroxide decontamination during high Clostridium difficile infection incidence. J Hosp Infect. 2014 May;87(1):25-33.
18. Kenters N, Huijskens EGW, de Wit SCJ, Sanders IGJM, van Rosmalen J, Kuijper EJ, et al. Effectiveness of various cleaning and disinfectant products on Clostridium difficile spores of PCR ribotypes 010, 014 and 027. Antimicrob Resist Infect Control. 2017 Jun 3;6:54.
19. Steindl G, Fiedler A, Huhulescu S, Wewalka G, Allerberger F. Effect of airborne hydrogen peroxide on spores of Clostridium difficile. Wien Klin Wochenschr. 2015 Jun;127(11-12):421-6.
20. Horn K, Otter JA. Hydrogen peroxide vapor room disinfection and hand hygiene improvements reduce Clostridium difficile infection, methicillin-resistant Staphylococcus aureus, vancomycin-resistant enterococci, and extended-spectrum β-lactamase. Am J Infect Control. 2015 December; 43(12): p. 1354 - 1356.
21. Mosci D, Marmo GW, Sciolino L, Zaccaro C, Antonellini R, Accogli L, et al. Automatic environmental disinfection with hydrogen peroxide and silver ions versus manual environmental disinfection with sodium hypochlorite: a multicentre randomized before-and-after trial. J Hosp Infect. 2017 Oct;97(2):175-179.
22. McCord J, Prewitt M, Dyakova E, Mookerjee S, Otter JA. Reduction in Clostridium difficile infection associated with the introduction of hydrogen peroxide vapour automated room disinfection. J Hosp Infect. 2016 Oct;94(2):185-7.
23. Krutova M, Kinross P, Barbut F, Hajdu A, Wilcox MH, Kuijper EJ, et al. How to: Surveillance of Clostridium difficile infections. Clin Microbiol Infect. 2018 May;24(5):469-475.
24. van Beurden YH, Bomers MK, van de Werff SD, Pompe EAPM, Spiering S, Vandenbroucke-Grauls CMJE, et al. Cost analysis of an outbreak of Clostridium difficile infeciton ribotype 027 in a Dutch tertiary care centre. J Hospl Infect. 2017 April; 95(4).