Abstract
Abstract Background Clostridioides difficile infection (CDI), the most common healthcare associated infection (HAI) in U.S. hospitals, causes half a million infections and 30,000 deaths annually. Prevention of hospital-onset (HO) CDI has quickly become a priority for most hospitals. Hospital exposure to C. difficile can occur through cross-contamination of healthcare personnel (HCP) hands or through shared environmental surfaces or equipment. Infection prevention measures focus on HCP hand hygiene and barrier precautions (i.e., gowns and gloves) and cleaning of environmental surfaces, especially for patients with known CDI. However, colonized patients can also serve as a reservoir for cross-contamination, and microbiological screening for C. difficile colonization is not routinely performed in healthcare. Methods We conducted a cluster randomized trial (CRT) in 10 inpatient units at 5 VA hospitals between April 2022 and December 2023 to evaluate the effectiveness of healthcare worker use of gloves for all patient contact (i.e., universal gloving) in reducing acquisition of C. difficile colonization (defined as negative PCR at admission and positive PCR at discharge) and HO-CDI (per NHSN LabID criteria, as adjudicated by facility infection prevention personnel for routine quality reporting). Results Of 9779 admissions, 780 consented to specimen collection. Table 1 displays preliminary data. At admission, 11.6% (intervention group) and 10.3% (control group) of patients tested were colonized with C. difficile. There were 474 patients with both admission and discharge perirectal swabs cultured for C. difficile. The C. difficile colonization acquisition rate was 12.9 per 1000 patient days of care (PDOC) for the intervention group and 10.3 for the control group (p=0.79). Unit-level aggregate data for the HO-CDI rate was 0.29 per 1000 PDOC for the intervention group and 0.57 for the control group (p=0.07). Conclusion No universal reduction in the acquisition of C. difficile was detected in acute care units implementing a gloving intervention compared with standard practice, but only 5% (474/9779) of admissions had complete testing data. A numerically lower but statistically nonsignificant HO-CDI rate was detected in the universal gloving group compared to standard practice. Disclosures Christopher D. Pfeiffer, MD, MHS, Department of Defense/Medpace: Grant/Research Support|Pfizer: Grant/Research Support
Published Version
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