Reducing length of stay to improve Clostridium difficile-related health outcomes

Abstract

Introduction: Patient length of stay (LOS) has long been linked with influencing transmission of Clostridium difficile infection. It has been hypothesised that the longer a patient stays in hospital, the greater their chances of infection. This study aimed to determine the extent to which C. difficile-related health outcomes could be improved by better management of inpatient LOS. Methods: A Markov model was constructed to compare five (5) different healthcare scenarios and measure the influence that these scenarios had on health outcomes such as; total number of infections avoided, number of quality-adjusted life years (QALYs) gained and number of patients requiring care in the intensive care unit (ICU). Results: Reducing patient LOS across the hospital is likely to result in an improvement in health outcomes. Compared to the current environment, each scenario yielded gains in QALYs and reductions in the total number of Clostridium difficile infections per annum in Australia. The results also showed that the greatest improvement in C. difficile-related health outcomes was found when a LOS reduction was coupled with an existing infection control practice such as hand hygiene, antimicrobial stewardship or environmental cleaning. Conclusion: Clostridium difficile-related health outcomes could be significantly improved if the average LOS of all admitted patients was reduced. However, trying to implement a further reduction in average LOS on clinicians who are already encouraged to juggle high occupancy rates and high patient throughput is bound to be a difficult task, undoubtedly requiring further study and rational consideration.