Reduced Clostridioides difficile infections in hospitalised older people through multiple quality improvement strategies

Author:

Dohrendorf Carla Maria12,Unkel Steffen3,Scheithauer Simone4,Kaase Martin4,Meier Volker5,Fenz Diana4,Sasse Jürgen6,Wappler Manfred7,Schweer-Herzig Jutta7,Friede Tim3,Reichard Utz8,Eiffert Helmut8,Nau Roland12,Seele Jana12

Affiliation:

1. Department of Geriatrics, Evangelisches Krankenhaus Göttingen-Weende, Göttingen, Germany

2. Department of Neuropathology, University Medical Center Göttingen, Göttingen, Germany

3. Department of Medical Statistics, University Medical Center Göttingen; Göttingen, Germany

4. Institute for Infection Control and Infectious Diseases, University Medical Center Göttingen; Göttingen, Germany

5. Hospital hygiene, Evangelisches Krankenhaus Göttingen-Weende; Göttingen, Germany

6. Clinic for Geriatric Medicine, DRK Kliniken-Nordhessen; Kaufungen, Germany

7. Clinic for Geriatric Medicine, Evangelisches Krankenhaus Gesundbrunnen Hofgeismar; Hofgeismar, Germany

8. MVZ Wagnerstibbe for Medical Microbiology, Göttingen, Germany

Abstract

Abstract Objectives To reduce infections with Clostridioides difficile (CDI) in geriatric patients by interventions easily implementable in standard clinical care. Methods Prevalence and incidence of CDI between January 2015 and February 2020 were analysed (n = 25,311 patients). Pre-intervention status was assessed from April 2016 to March 2017 (n = 4,922). Between May 2017 and August 2019, a monocentric interventional crossover study (n = 4,655) was conducted including standard care and three interventions: (A) sporicidal cleaning of hospital wards, (B) probiotics and (C) improvement in personal hygiene for CDI patients. This was followed by a multicentric comparison of the interventional bundle (A + B + C) between September 2019 and February 2020 (n = 2,593) with the pre-intervention phase. In 98 CDI cases and matched controls individual risk factors for the development of CDI were compared. Results Time series analyses of CDI cases revealed a reduction in the prevalence of CDI in all three participating centres prior to the multicentric intervention phase. In the monocentric phase, no effect of individual interventions on CDI prevalence was identified. However, an aggregated analysis of CDI cases comparing the pre-intervention and the multicentric phase revealed a significant reduction in CDI prevalence. Risk factors for the development of CDI included use of antibiotics, anticoagulants, previous stay in long-term care facilities, prior hospital admissions, cardiac and renal failure, malnutrition and anaemia. Conclusions The observed reduction in CDI may be attributed to heightened awareness of the study objectives and specific staff training. Individual interventions did not appear to reduce CDI prevalence. A further randomised trial would be necessary to confirm whether the bundle of interventions is truly effective.

Publisher

Oxford University Press (OUP)

Subject

Geriatrics and Gerontology,Aging,General Medicine

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