Keywords
c difficile outbreak
epidemiological surveillance
infection prevention
joinpoint regression
epidemiological surveillance
infection prevention
joinpoint regression
Abstract
INTRODUCTION: Clostridium difficile infection (CDI) is currently considered the most common cause of health care-associated infections. The aim is to describe the trend of CDI in an Italian hospital and to assess the efficacy of the measures adopted to manage the burden.
METHODS: we looked at CDI from 2016 to 2018. The incidence rate of CDIs was calculated as the number of new infected persons per month by the overall length of stay (incidence per 10,000 patient-days). Changes in the CDI rate during the period considered were analysed using a joinpoint regression model.
RESULTS: thanks to the monitoring activity it was possible to adopt a new protocol, in order to manage CDI: the CDI episodes decreased from 85 in 2017 to 31 in 2018 (63% decrease). The joinpoint regression model was a useful tool to identify an important decrement during 2017, statistically significant (slope=-15.84; p= 0.012).
CONCLUSIONS: reports based on routine laboratory data can accurately measure population burden of CDI with limited surveillance resources. This acitivity can help target prevention programs and evaluate their effect.
References
[1] Ofosu A. Clostridium difficile infection: A review of current and emerging therapies. Ann Gastroenterol 2016;29:147–154. doi: 10.20524/aog.2016.0006.
[2] Ramai D, Noorani A, Ofosu A, Ofori E, Reddy M, Gasperino J. Practice measures for controlling and preventing hospital associated Clostridium difficile infections. Hospital Practice 2019;47(3):123–129. doi: 10.1080/21548331.2019.1627851.
[3] Balsells E, Shi T, Leese C, Lyell I, Burrows J, Wiuff C, Campbell H, Kyaw MH, Nair H. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health 2019;9(1):010407. doi: 10.7189/jogh.09.010407.
[4] Petrosillo N, Ravasio R. Il costo ospedaliero di trattamento di un episodio di infezione da Clostridium difficile in Italia. Glob Reg Health Technol Assess 2017;4(1):e77-e83. doi: https://doi.org/10.5301/grhta.5000257.
[5] Jullian-Desayes I, Pharmd CL, Mallaret MR, Brun-Buisson C, Pharmd B. State of the Science Review Clostridium difficile contamination of health care workers’ hands and its potential contribution to the spread of infection: Review of the literature. American Journal of Infection Control 2017;45:51–59. doi: 10.1016/j.ajic.2016.08.017.
[6] European Centre for Disease Prevention and Control. European Surveillance of Clostridioides (Clostridium) difficile infections. Surveillance protocol, version 2.4. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/clostridium-difficile-infections-EU-surveillance-protocol-vers2.4.pdf. Accessed on 5 February 2020.
[7] Cofini V, Capodacqua A, Calisse S, Galassi I, Cipollone L, Necozione S. Trend analysis and factors associated with biological injuries among health care workers in Southern Italy. Med Lav 2018;109,4:308-315. doi: https://doi.org/10.23749/mdl.v109i4.7245
[8] European Centre for Disease Prevention and Control. Healthcare-associated infections: Clostridium difficile infections - Annual Epidemiological Report for 2016. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2016-C-difficile_0.pdf. Accessed on 5 February 2020.
[9] Nsubuga P, White ME, Thacker SB, Anderson MA, Blount SB, Broome CV, Chiller TM, Espitia V, Imtiaz R, Sosin D, Stroup DF, Tauxe RV, Vijayaraghavan M, Trostle M. Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2006. pp. 997-1015
[10] Weiss K, Boisvert A, Chagnon M, Duchesne C, Habash S, Lepage Y, Letourneau J, Raty J, Savoie M. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol 2009;30:156-62. doi: 10.1086/593955.
[11] Società Italiana Multidisciplinare per la Prevenzione delle Infezioni nelle Organizzazioni Sanitarie. Prevenzione e controllo delle infezioni da Clostridium difficile. Available at: http://www.simpios.it/public/ufiles/Prevenzione%20e%20controllo%20delle%20infezioni%20da%20Clostridium%20Difficile.pdf. Accessed on 5 February 2020.
[12] Perdelli F, Dallera M, Cristina ML, Sartini M, Ottria G, Spagnolo AM, Orlando P. A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides. Int J Hyg Environ Health 2008;211:213-8. doi: . https://doi.org/10.1016/j.ijheh.2007.04.002.
[13] Orlando P, Cristina ML, Dallera M, Ottria G, Vitale A, Badolati G. Surface disinfection: evaluation of the efficacy of a nebulization system spraying hydrogen peroxide. J Prev Med Hyg 2008;49:116-9
[14] Spagnolo AM, Orlando P, Panatto D, Amicizia D, Perdelli F, Cristina ML. Staphylococcus aureus with reduced susceptibility to vancomycin in healthcare settings. J Prev Med Hyg 2014;55:137-44.
[15] Spagnolo AM, Sartini M, Battistella A, Casini B, Lo Pinto G, Schinca E, Cristina ML, Hospital Infection Control Operating Group Galliera Hospital. A Clostridium difficile outbreak in an Italian hospital: The efficacy of the multi-disciplinary and multifaceted approach. J. Prev. Med. Hyg. 2018;59:132–138.
[16] Ali S, Muzslay M, Bruce M, Jeanes A, Moore G, Wilson AP. Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of meticillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms. J Hosp Infect 2016;93:70-7. doi: 10.1016/j.jhin.2016.01.016
[17] Martinez FJ, Leffler DA, Kelly CP. Clostridium difficile outbreaks: prevention and treatment strategies. Risk Manag Healthc Policy 2012;5:55-64. doi: 10.2147/RMHP.S13053
[18] Fawley WN, Underwood S, Freeman J, Baines SD, Saxton K, Stephenson K, Owens RC Jr, Wilcox MH. Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains. Infect Control Hosp Epidemiol 2007;28:920-5. doi: 10.1086/519201
[19] Revolinski S, Munoz-Price L. Clostridium difficile Exposures, Colonization, and the Microbiome: Implications for Prevention. Infect Control Hosp Epidemiol 2018;39(5), 596-602. doi: https://doi.org/10.1017/ice.2018.36.
[2] Ramai D, Noorani A, Ofosu A, Ofori E, Reddy M, Gasperino J. Practice measures for controlling and preventing hospital associated Clostridium difficile infections. Hospital Practice 2019;47(3):123–129. doi: 10.1080/21548331.2019.1627851.
[3] Balsells E, Shi T, Leese C, Lyell I, Burrows J, Wiuff C, Campbell H, Kyaw MH, Nair H. Global burden of Clostridium difficile infections: a systematic review and meta-analysis. J Glob Health 2019;9(1):010407. doi: 10.7189/jogh.09.010407.
[4] Petrosillo N, Ravasio R. Il costo ospedaliero di trattamento di un episodio di infezione da Clostridium difficile in Italia. Glob Reg Health Technol Assess 2017;4(1):e77-e83. doi: https://doi.org/10.5301/grhta.5000257.
[5] Jullian-Desayes I, Pharmd CL, Mallaret MR, Brun-Buisson C, Pharmd B. State of the Science Review Clostridium difficile contamination of health care workers’ hands and its potential contribution to the spread of infection: Review of the literature. American Journal of Infection Control 2017;45:51–59. doi: 10.1016/j.ajic.2016.08.017.
[6] European Centre for Disease Prevention and Control. European Surveillance of Clostridioides (Clostridium) difficile infections. Surveillance protocol, version 2.4. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/clostridium-difficile-infections-EU-surveillance-protocol-vers2.4.pdf. Accessed on 5 February 2020.
[7] Cofini V, Capodacqua A, Calisse S, Galassi I, Cipollone L, Necozione S. Trend analysis and factors associated with biological injuries among health care workers in Southern Italy. Med Lav 2018;109,4:308-315. doi: https://doi.org/10.23749/mdl.v109i4.7245
[8] European Centre for Disease Prevention and Control. Healthcare-associated infections: Clostridium difficile infections - Annual Epidemiological Report for 2016. Available at: https://www.ecdc.europa.eu/sites/default/files/documents/AER_for_2016-C-difficile_0.pdf. Accessed on 5 February 2020.
[9] Nsubuga P, White ME, Thacker SB, Anderson MA, Blount SB, Broome CV, Chiller TM, Espitia V, Imtiaz R, Sosin D, Stroup DF, Tauxe RV, Vijayaraghavan M, Trostle M. Public Health Surveillance: A Tool for Targeting and Monitoring Interventions. In: Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, editors. Disease Control Priorities in Developing Countries. 2nd edition. Washington, DC: The International Bank for Reconstruction and Development / The World Bank; 2006. pp. 997-1015
[10] Weiss K, Boisvert A, Chagnon M, Duchesne C, Habash S, Lepage Y, Letourneau J, Raty J, Savoie M. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol 2009;30:156-62. doi: 10.1086/593955.
[11] Società Italiana Multidisciplinare per la Prevenzione delle Infezioni nelle Organizzazioni Sanitarie. Prevenzione e controllo delle infezioni da Clostridium difficile. Available at: http://www.simpios.it/public/ufiles/Prevenzione%20e%20controllo%20delle%20infezioni%20da%20Clostridium%20Difficile.pdf. Accessed on 5 February 2020.
[12] Perdelli F, Dallera M, Cristina ML, Sartini M, Ottria G, Spagnolo AM, Orlando P. A new microbiological problem in intensive care units: environmental contamination by MRSA with reduced susceptibility to glycopeptides. Int J Hyg Environ Health 2008;211:213-8. doi: . https://doi.org/10.1016/j.ijheh.2007.04.002.
[13] Orlando P, Cristina ML, Dallera M, Ottria G, Vitale A, Badolati G. Surface disinfection: evaluation of the efficacy of a nebulization system spraying hydrogen peroxide. J Prev Med Hyg 2008;49:116-9
[14] Spagnolo AM, Orlando P, Panatto D, Amicizia D, Perdelli F, Cristina ML. Staphylococcus aureus with reduced susceptibility to vancomycin in healthcare settings. J Prev Med Hyg 2014;55:137-44.
[15] Spagnolo AM, Sartini M, Battistella A, Casini B, Lo Pinto G, Schinca E, Cristina ML, Hospital Infection Control Operating Group Galliera Hospital. A Clostridium difficile outbreak in an Italian hospital: The efficacy of the multi-disciplinary and multifaceted approach. J. Prev. Med. Hyg. 2018;59:132–138.
[16] Ali S, Muzslay M, Bruce M, Jeanes A, Moore G, Wilson AP. Efficacy of two hydrogen peroxide vapour aerial decontamination systems for enhanced disinfection of meticillin-resistant Staphylococcus aureus, Klebsiella pneumoniae and Clostridium difficile in single isolation rooms. J Hosp Infect 2016;93:70-7. doi: 10.1016/j.jhin.2016.01.016
[17] Martinez FJ, Leffler DA, Kelly CP. Clostridium difficile outbreaks: prevention and treatment strategies. Risk Manag Healthc Policy 2012;5:55-64. doi: 10.2147/RMHP.S13053
[18] Fawley WN, Underwood S, Freeman J, Baines SD, Saxton K, Stephenson K, Owens RC Jr, Wilcox MH. Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains. Infect Control Hosp Epidemiol 2007;28:920-5. doi: 10.1086/519201
[19] Revolinski S, Munoz-Price L. Clostridium difficile Exposures, Colonization, and the Microbiome: Implications for Prevention. Infect Control Hosp Epidemiol 2018;39(5), 596-602. doi: https://doi.org/10.1017/ice.2018.36.