Dec 032014
 

Excess length of stay and mortality due to Clostridium difficile infection: a multi-state modelling approach.

J Hosp Infect. 2014 Sep 18;88(4):213-217

Authors: van Kleef E, Green N, Goldenberg SD, Robotham JV, Cookson B, Jit M, Edmunds WJ, Deeny SR

Abstract
BACKGROUND: The burden of healthcare-associated infections, such as healthcare-acquired Clostridium difficile (HA-CDI), can be expressed in terms of additional length of stay (LOS) and mortality. However, previous estimates have varied widely. Although some have considered time of infection onset (time-dependent bias), none considered the impact of severity of HA-CDI; this was the primary aim of this study.
METHODS: The daily risk of in-hospital death or discharge was modelled using a Cox proportional hazards model, fitted to data on patients discharged in 2012 from a large English teaching hospital. We treated HA-CDI status as a time-dependent variable and adjusted for confounders. In addition, a multi-state model was developed to provide a clinically intuitive metric of delayed discharge associated with non-severe and severe HA-CDI respectively.
FINDINGS: Data comprised 157 (including 48 severe) HA-CDI cases among 42,618 patients. HA-CDI reduced the daily discharge rate by nearly one-quarter [hazard ratio (HR): 0.72; 95% confidence interval (CI): 0.61-0.84] and increased the in-hospital death rate by 75% compared with non-HA-CDI patients (HR: 1.75; 95% CI: 1.16-2.62). Whereas overall HA-CDI resulted in a mean excess LOS of about seven days (95% CI: 3.5-10.9), severe cases had an average excess LOS which was twice (∼11.6 days; 95% CI: 3.6-19.6) that of the non-severe cases (about five days; 95% CI: 1.1-9.5).
CONCLUSION: HA-CDI contributes to patients' expected LOS and risk of mortality. However, when quantifying the health and economic burden of hospital-onset of HA-CDI, the heterogeneity in the impact of HA-CDI should be accounted for.

PMID: 25441017 [PubMed - as supplied by publisher]

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Sep 232014
 
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Microbiological comparison of hand-drying methods: the potential for contamination of the environment, user, and bystander.

J Hosp Infect. 2014 Aug 27;

Authors: Best EL, Parnell P, Wilcox MH

Abstract
BACKGROUND: The efficiency of hand drying is important in preventing pathogen spread, but knowledge surrounding which drying methods contribute least towards contamination of the environment and users is limited.
AIM: To compare the propensity of three common hand-drying methods (jet air, warm air dryers, and paper towels) to contaminate the environment, users, and bystanders.
METHODS: Hands were coated in lactobacilli to simulate poorly washed, contaminated hands, and dried. The investigation comprised 120 air-sampling tests (60 tests and 60 controls), divided into close and 1m proximity from the drying process. Separate tests used hands coated in paint to visualize droplet dispersal.
FINDINGS: Air bacterial counts in close proximity to hand drying were 4.5-fold higher for the jet air dryer (70.7cfu) compared with the warm air dryer (15.7cfu) (P = 0.001), and 27-fold higher compared with use of paper towels (2.6cfu) (P < 0.001). Airborne counts were also significantly different during use of towel drying versus warm air dryer (P = 0.001). A similar pattern was seen for bacterial counts at 1m away. Visualization experiments demonstrated that the jet air dryer caused the most droplet dispersal.
CONCLUSION: Jet air and warm air dryers result in increased bacterial aerosolization when drying hands. These results suggest that air dryers may be unsuitable for use in healthcare settings, as they may facilitate microbial cross-contamination via airborne dissemination to the environment or bathroom visitors.

PMID: 25237036 [PubMed - as supplied by publisher]

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Sep 182014
 
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Clostridium difficile ribotype 027 is most prevalent among inpatients admitted from long-term care facilities.

J Hosp Infect. 2014 Jul 30;

Authors: Archbald-Pannone LR, Boone JH, Carman RJ, Lyerly DM, Guerrant RL

Abstract
Intestinal inflammation was evaluated using faecal lactoferrin and ribotype in 196 hospitalized adults with Clostridium difficile infection to determine the impact of ribotype 027 in long-term care facilities (LTCFs). LTCF residents (n = 28) had greater antibiotic use (P = 0.049) and more ribotype 027 infection [odds ratio (OR): 4.87; 95% confidence interval (CI): 2.02-11.74; P < 0.01], compared to those admitted from home. Patients infected with ribotype 027 strains had worse six-month mortality (OR: 1.90; 95% CI: 1.08-3.34; P = 0.03) and more inflammation (95.26 vs 36.08μg/mL; P = 0.006), compared to those infected with non-027 strains. This study was not designed to determine acquisition site, but, in this population, suggests that the location from which the patient has been admitted is strongly associated with ribotype 027 and more severe C. difficile disease.

PMID: 25228227 [PubMed - as supplied by publisher]

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Jul 062014
 
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Hospitalization stay and costs attributable to Clostridium difficile infection: a critical review.

J Hosp Infect. 2014 May 17;

Authors: Gabriel L, Beriot-Mathiot A

Abstract
In most healthcare systems, third-party payers fund the costs for patients admitted to hospital for Clostridium difficile infection (CDI) whereas, for CDI cases arising as complications of hospitalization, not all related costs are refundable to the hospital. We therefore aimed to critically review and categorize hospital costs and length of hospital stay (LOS) attributable to Clostridium difficile infection and to investigate the economic burden associated with it. A comprehensive literature review selected papers describing the costs and LOS for hospitalized patients as outcomes of CDI, following the use of statistics to identify costs and LOS solely attributable to CDI. Twenty-four studies were selected. Estimated attributable costs, all ranges expressed in US dollars, were $6,774-$10,212 for CDI requiring admission, $2,992-$29,000 for hospital-acquired CDI, and $2,454-$12,850 where no categorization was made. The ranges for LOS values were 5-13.6, 2.7-21.3, and 2.8-17.9 days, respectively. The categorization of CDI attributable costs allows budget holders to anticipate the cost per CDI case, a perspective that should enrich the design of appropriate incentives for the various budget holders to invest in prevention so that CDI prevention is optimized globally.

PMID: 24996516 [PubMed - as supplied by publisher]

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Jun 252014
 

National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review.

J Hosp Infect. 2014 May 28;

Authors: Martin M, Zingg W, Knoll E, Wilson C, Dettenkofer M, the PROHIBIT study group

Abstract
BACKGROUND: Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention.
AIM: To overview current national European guidelines for C. difficile infection (CDI) prevention and review the recommendations in respect of their evidence base and conformity to each other and the European Centre for Disease Control and Prevention (ECDC) guidance.
METHODS: In 34 European countries, the ECDC healthcare-associated infection (HCAI) surveillance National Contact Points and other HCAI experts (NCPs) were invited to complete an online questionnaire and to supply their guidelines. Guidelines not available in English, French or German were translated into English. For the qualitative analysis, a matrix with key measures based on the 2008 ECDC guidance was established. The review process was conducted independently by two reviewers.
RESULTS: All 34 NCPs responded to the questionnaire and supplied 15 guidelines in total. Six of 34 (18%) countries reported having used the ECDC guidance as a basis for the development or revision of their national guideline. There was wide variation in the scope and detailing. Only six of the documents and the ECDC guidance supplied a rating for the strength of recommendations. The rating systems varied in how the categories were defined. Furthermore, the stated strength for similar measures varied across different guidelines.
CONCLUSION: The ECDC guidance has not yet had a strong influence on the development or revision of national CDI prevention guidelines. One possible explanation for the variations is the necessity to adapt recommendations to national conditions. The use of internationally recognized instruments for the development of guidelines could help to improve their quality. Recommendations about monitoring or auditing the implementation would make them more useful.

PMID: 24957805 [PubMed - as supplied by publisher]

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Jun 152014
 
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Implications of targeted versus universal admission screening for meticillin-resistant Staphylococcus aureus carriage in a London hospital.

J Hosp Infect. 2014 May 10;

Authors: Otter JA, Tosas-Auguet O, Herdman MT, Williams B, Tucker D, Edgeworth JD, French GL

Abstract
Universal admission screening for meticillin-resistant Staphylococcus aureus (MRSA) has been performed in England since 2010. We evaluated the predictive performance of a regression model derived from the first year of universal screening for detecting MRSA at hospital admission. If we had used our previous targeted screening policy, 75% fewer patients (21,699 per year) would have been screened. However, this would have identified only ∼55% of all MRSA carriers, 65% of healthcare-associated MRSA strains, and 40% of community-associated strains. Failing to identify ∼45% of patients (262 per year) carrying MRSA at hospital admission may have implications for MRSA control.

PMID: 24928784 [PubMed - as supplied by publisher]

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