Impact of a C. difficile infection (CDI) reduction bundle and its components on CDI diagnosis and prevention
| Autor: | Clayton H. Brown, Gwen Robinson, Gita Nadimpalli, Daniel J. Morgan, Daniel L. Lemkin, Lucy E. Wilson, Mojdeh S. Heavner, Surbhi Leekha, Natalia Blanco, Emily L. Heil, Rebecca Perlmutter |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
genetic structures Epidemiology Enteric precautions Clinical decision support system Interrupted Time Series Analysis 03 medical and health sciences 0302 clinical medicine Acute care medicine Humans 030212 general & internal medicine Antibiotic use Cross Infection 0303 health sciences Maryland Clostridioides difficile 030306 microbiology business.industry Health Policy Public Health Environmental and Occupational Health C difficile Hospitals Infectious Diseases Bundle Emergency medicine Clostridium Infections business Clostridioides |
| Zdroj: | American Journal of Infection Control. 49:319-326 |
| ISSN: | 0196-6553 |
| Popis: | Background Published bundles to reduce Clostridioides difficile Infection (CDI) frequently lack information on compliance with individual elements. We piloted a computerized clinical decision support-based intervention bundle and conducted detailed evaluation of several intervention-related measures. Methods A quasi-experimental study of a bundled intervention was performed at 2 acute care community hospitals in Maryland. The bundle had five components: (1) timely placement in enteric precautions, (2) appropriate CDI testing, (3) reducing proton-pump inhibitor (PPI) use, (4) reducing high-CDI risk antibiotic use, and (5) optimizing use of a sporicidal agent for environmental cleaning. Chi-square and Kruskal-Wallis tests were used to compare measure differences. An interrupted time series analysis was used to evaluate impact on hospital-onset (HO)-CDI. Results Placement of CDI suspects in enteric precautions before test results did not change. Only hospital B decreased the frequency of CDI testing and reduced inappropriate testing related to laxative use. Both hospitals reduced the use of PPI and high-risk antibiotics. A 75% decrease in HO-CDI immediately postimplementation was observed for hospital B only. Conclusion A CDI reduction bundle showed variable impact on relevant measures. Hospital-specific differential uptake of bundle elements may explain differences in effectiveness, and emphasizes the importance of measuring processes and intermediate outcomes. |
| Databáze: | OpenAIRE |
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