Details:

Alternative Title:
PLoS One
Publisher's site:
http://dx.doi.org/10.1371/journal.pone.0080671
Personal Author:
Rubin, Michael A. ; Jones, Makoto ; Leecaster, Molly ; Khader, Karim ; Ray, Willy ; ... More +
Rubin, Michael A. ; Jones, Makoto ; Leecaster, Molly ; Khader, Karim ; Ray, Willy ; Huttner, Angela ; Huttner, Benedikt ; Toth, Damon ; Sablay, Theodore ; Borotkanics, Robert J. ; Gerding, Dale N. ; Samore, Matthew H. Less -
Description:
Background

Clostridium difficile is one of the most common and important nosocomial pathogens, causing severe gastrointestinal disease in hospitalized patients. Although "bundled" interventions have been proposed and promoted, optimal control strategies remain unknown.

Methods

We designed an agent-based computer simulation of nosocomial C. difficile transmission and infection, which included components such as: patients and health care workers, and their interactions; room contamination via C. difficile shedding; C. difficile hand carriage and removal via hand hygiene; patient acquisition of C. difficile via contact with contaminated rooms or health care workers; and patient antimicrobial use. We then introduced six interventions, alone and "bundled" together: aggressive C. difficile testing; empiric isolation and treatment of symptomatic patients; improved adherence to hand hygiene and contact precautions; improved use of soap and water for hand hygiene; and improved environmental cleaning. All interventions were tested using values representing base-case, typical intervention, and optimal intervention scenarios.

Findings

In the base-case scenario, C. difficile infection rates ranged from 8–21 cases/10,000 patient-days, with a case detection fraction between 32%–50%. Implementing the "bundle" at typical intervention levels had a large impact on C. difficile acquisition and infection rates, although intensifying the intervention to optimal levels had much less additional impact. Most of the impact came from improved hand hygiene and empiric isolation and treatment of suspected C. difficile cases.

Conclusion

A "bundled" intervention is likely to reduce nosocomial C. difficile infection rates, even under typical implementation conditions. Real-world implementation of the "bundle" should focus on those components of the intervention that are likely to produce the greatest impact on C. difficile infection rates, such as hand hygiene and empiric isolation and treatment of suspected cases.


Subject:
[+]
Clostridium Difficile Computer Simulation Enterocolitis, Pseudomembranous Humans Infection Control Models, Biological Research Article
Source:
PLoS One. 2013; 8(11).
Pubmed ID:
24278304
Pubmed Central ID:
PMC3836736
Document Type:
Journal Article
Funding:
CDC 07FED706506/PHS HHS/United States
Collection(s):
CDC Public Access
Main Document Checksum:
[+]
urn:sha256:5c58491522ed71a9928bec8257f80c7a45dd41f7f335c193c1d11475bdf8ce8f
Download URL:
https://stacks.cdc.gov/view/cdc/22556/cdc_22556_DS1.pdf
File Type:

Supporting Files

• 	pone.0080671.g004.jpg	jpeg
  	pone.0080671.nxml	txt
  	pone.0080671.s001.docx	docx
  	pone.0080671.t001.gif	gif
  	pone.0080671.t001.jpg	jpeg
  	pone.0080671.t002.gif	gif
  	pone.0080671.t002.jpg	jpeg
  	license.txt	txt
  	pone.0080671.g001.gif	gif
  	pone.0080671.g001.jpg	jpeg
  	pone.0080671.g002.gif	gif
  	pone.0080671.g002.jpg	jpeg
  	pone.0080671.g003.gif	gif
  	pone.0080671.g003.jpg	jpeg
  	pone.0080671.g004.gif	gif

More +