Abstract
BackgroundClostridium difficile infection (CDI) is understudied in limited resource settings. In addition, provider awareness of CDI as a prevalent threat is unknown. An assessment of current facilitators and barriers to CDI identification, management, and prevention is needed in limited resource settings to design and evaluate quality improvement strategies to effectively minimize the risk of CDI.MethodsOur study aimed to identify CDI perceptions and practices among healthcare providers in South African secondary hospitals to identify facilitators and barriers to providing quality CDI care. Qualitative interviews (11 physicians, 11 nurses, 4 pharmacists,) and two focus groups (7 nurses, 3 pharmacists) were conducted at three district level hospitals in the Cape Town Metropole. Semi-structured interviews elicited provider perceived facilitators, barriers, and opportunities to improve clinical workflow from patient presentation through CDI (1) Identification, (2) Diagnosis, (3) Treatment, and (4) Prevention. In addition, a summary provider CDI knowledge score was calculated for each interviewee for seven components of CDI and management.ResultsMajor barriers identified were knowledge gaps in characteristics of C. difficile identification, diagnosis, treatment, and prevention. The median overall CDI knowledge score (scale 0–7) from individual interviews was 3 [interquartile range 0.25, 4.75]. Delays in C. difficile testing workflow were identified. Participants perceived supplies for CDI management and prevention were usually available; however, hand hygiene and use of contact precautions was inconsistent.ConclusionsOur analysis provides a detailed description of the facilitators and barriers to CDI workflow and can be utilized to design quality improvement interventions among limited resource settings.
Highlights
Clostridium difficile infection (CDI) is understudied in limited resource settings
Healthcare provider responsibility and accountability for components of CDI management emerged as an organizational culture theme from the interviews
Thematic saturation of barriers and facilitators to CDI management was reached across the health care provider types [8]
Summary
Clostridium difficile infection (CDI) is understudied in limited resource settings. Clostridium difficile infection (CDI) is an increasingly important healthcare-associated infection associated with long hospitalisations and high patient morbidity and mortality [1]. CDI in these hospitals is prevalent supporting extensive CDI prevention and control measures. CDI is understudied in low and limited resource settings, including most African countries. A study at a tertiary hospital in Cape Town, South Africa found 22% of stool samples from patients with suspected CDI diarrhoea were C. difficile positive [2]. Patients in South Africa are disproportionately affected by HIV and tuberculosis (TB) and experience known CDI risk factors of prior hospital and antibiotic exposure—exposures that
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