Abstract
A high degree of vigilance and appropriate diagnostic methods are required to detect Clostridioides difficile infection (CDI). We studied the effectiveness of a multimodal training program for improving CDI surveillance and prevention. Between 2011 and 2016, this program was made available to healthcare staff of acute care hospitals in Catalonia. The program included an online course, two face-to-face workshops and dissemination of recommendations on prevention and diagnosis. Adherence to the recommendations was evaluated through surveys administered to the infection control teams at the 38 participating hospitals. The incidence of CDI increased from 2.20 cases/10 000 patient-days in 2011 to 3.41 in 2016 (P < 0.001). The number of hospitals that applied an optimal diagnostic algorithm rose from 32.0% to 71.1% (P = 0.002). Hospitals that applied an optimal diagnostic algorithm reported a higher overall incidence of CDI (3.62 vs. 1.92, P < 0.001), and hospitals that were more active in searching for cases reported higher rates of hospital-acquired CDI (1.76 vs. 0.84, P < 0.001). The results suggest that the application of a multimodal training strategy was associated with a significant rise in the reporting of CDI, as well as with an increase in the application of the optimal diagnostic algorithm.
Highlights
IntroductionClostridioides difficile (formerly Clostridium difficile) is the most frequent cause of healthcare-related infectious diarrhoea, which mainly affects elderly patients presenting risk factors such as the use of antibiotics [1]
Clostridioides difficile is the most frequent cause of healthcare-related infectious diarrhoea, which mainly affects elderly patients presenting risk factors such as the use of antibiotics [1]
The aim of this study was to evaluate the effectiveness of a multimodal training program in improving the surveillance and prevention of Clostridioides difficile infection (CDI) in hospitals participating in the nosocomial infection surveillance program in Catalonia (VINCat) [9]
Summary
Clostridioides difficile (formerly Clostridium difficile) is the most frequent cause of healthcare-related infectious diarrhoea, which mainly affects elderly patients presenting risk factors such as the use of antibiotics [1]. The diagnosis of Clostridioides difficile infection (CDI) is based on clinical suspicion and on the application of adequate laboratory techniques. The prevention of CDI in the healthcare setting depends on early diagnosis and the application of a set of measures including hand hygiene and the cleaning and disinfection of surfaces, and the proper use of antibiotics [1]. According to a study conducted in Europe between 2011 and 2013, its incidence varies across countries from 0 to 36.3/10 000 patient-days [7], due in part to the low diagnostic suspicion and the application of suboptimal diagnostic methods; in that study, only 52% of hospitals used an optimal diagnostic algorithm [7]. The training of health professionals is fundamental in CDI prevention programs in order to improve the detection of cases and to increase compliance with preventive measures [8]
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