Comparing intervention strategies for reducing Clostridioides difficile transmission in acute healthcare settings: an agent-based modeling study

Brittany Stephenson,Jason Bintz,Judy Day,Erik R Dubberke,Suzanne Lenhart,Eduardo Ponce,Cristina Lanzas

doi:10.1186/s12879-020-05501-w

Abstract

BackgroundClostridioides difficile infection (CDI) is one of the most common healthcare infections. Common strategies aiming at controlling CDI include antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions. Mathematical models provide a framework to evaluate control strategies. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting.MethodsWe developed an agent-based model that simulates the transmission of C. difficile in medical wards. This model explicitly incorporates healthcare workers (HCWs) as vectors of transmission, tracks individual patient antibiotic histories, incorporates varying risk levels of antibiotics with respect to CDI susceptibility, and tracks contamination levels of ward rooms by C. difficile. Interventions include two forms of antimicrobial stewardship, increased environmental decontamination through room cleaning, improved HCW compliance, and a preliminary assessment of vaccination.ResultsIncreased HCW compliance with CDI patients was ranked as the most effective intervention in decreasing colonizations, with reductions up to 56%. Antibiotic stewardship practices were highly ranked after contact precaution compliance. Vaccination and reduction of high-risk antibiotics were the most effective intervention in decreasing CDI. Vaccination reduced CDI cases to up to 90%, and the reduction of high-risk antibiotics decreased CDI cases up to 23%.ConclusionsOverall, interventions that decrease patient susceptibility to colonization by C. difficile, such as antibiotic stewardship, were the most effective interventions in reducing both colonizations and CDI cases.

Highlights

Clostridioides difficile infection (CDI) is one of the most common healthcare infections
Model setting We developed our Agent-based Model (ABM) using NetLogo, a coding language and modeling environment primarily used for the creation of ABMs [33]
Systematic reviews and meta-analysis of epidemiological studies consistently conclude that antibiotic stewardship is an effective strategy against C. difficile, with overall reductions of C. difficile infections ranging from 32 to 52% depending on settings and co-implementation of control strategies [45,46,47]

Summary

Introduction

Clostridioides difficile infection (CDI) is one of the most common healthcare infections. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting. Clostridioides difficile–an anaerobic, gram-positive, endospore-forming bacterium–is the leading cause of infectious diarrhea in United States hospitals and one of the most common healthcare-associated infections [1]. C. difficile causes approximately 223,900 infections in hospitalized patients and 12,800 associated deaths in the U.S per year [4]. The cost associated with C. difficile infection (CDI) in U.S acute-care facilities alone has been estimated to be as much as $4.8 billion annually [5]. Because CDI is one of the most common nosocomial infections among patients in healthcare facilities, there is a critical need to better identify primary sources of transmission and optimal methods for prevention

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