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. 2023 Mar;44(3):440-446.
doi: 10.1017/ice.2022.84. Epub 2022 Jun 20.

Mitigating hospital-onset Clostridioides difficile: The impact of an optimized environmental hygiene program in eight hospitals

Philip C Carling  1 , Lyndsay M O'Hara  2 , Anthony D Harris  3 , Russell Olmsted  4
Affiliations

Mitigating hospital-onset Clostridioides difficile: The impact of an optimized environmental hygiene program in eight hospitals

Philip C Carling et al. Infect Control Hosp Epidemiol. 2023 Mar.

Abstract

Objective: To evaluate the impact of a standardized, process-validated intervention utilizing daily hospital-wide patient-zone sporicidal disinfectant cleaning on incidence density of healthcare-onset Clostridioides difficile infection (HO-CDI) standardized infection ratios (SIRs).

Design: Multi-site, quasi-experimental study, with control hospitals and a nonequivalent dependent variable.

Setting: The study was conducted across 8 acute-care hospitals in 6 states with stable endemic HO-CDI SIRs.

Methods: Following an 18-month preintervention control period, each site implemented a program of daily hospital-wide sporicidal disinfectant patient zone cleaning. After a wash-in period, thoroughness of disinfection cleaning (TDC) was monitored prospectively and optimized with performance feedback utilizing a previously validated process improvement program. Mean HO-CDI SIRs were calculated by quarter for the pre- and postintervention periods for both the intervention and control hospitals. We used a difference-in-differences analysis to estimate the change in the average HO-CDI SIR and HO-CAUTI SIR for the pre- and postintervention periods.

Results: Following the wash-in period, the TDC improved steadily for all sites and by 18 months was 93.6% for the group. The mean HO-CDI SIRs decreased from 1.03 to 0.6 (95% CI, 0.13-0.75; P = .009). In the adjusted difference-in-differences analysis in comparison to controls, there was a 0.55 reduction (95% CI, -0.77 to -0.32) in HO-CDI (P < .001) or a 50% relative decrease from baseline.

Conclusions: This study represents the first multiple-site, quasi-experimental study with control hospitals and a nonequivalent dependent variable to evaluate a 4-component intervention on HO-CDI. Following ongoing improvement in cleaning thoroughness, there was a sustained 50% decrease in HO-CDI SIRs compared to controls.

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Figures

Fig. 1.
Fig. 1.
Elements of Clostridioides difficile environmental epidemiology.
Fig. 2A
Fig. 2A
. Thoroughness of cleaning in 8 intervention hospitals.
Fig. 2B.
Fig. 2B.
Endemic HO-SIRs in 8 intervention hospitals.
Fig. 3.
Fig. 3.
Difference-in-difference analysis of (A) hospital-onset C. difficile infection (HO-CDI) and (B) hospital-onset catheter-associated urinary tract infection (HO-CAUTI).
Fig. 4.
Fig. 4.
Causal variables possibly effecting outcomes.
See this image and copyright information in PMC

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