ArticleAntimicrobial resistance and infection control2025
Impact of targeted interventions on healthcare-acquired infection prevention and control of Clostridium difficile infections.
Article in Antimicrobial resistance and infection control, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundClostridium difficile infection (CDI) is a leading cause of hospital-acquired infections, particularly in high-risk environments like intensive care units (ICUs). Effective prevention requires comprehensive interventions, including antimicrobial stewardship, infection control measures, and healthcare worker training to mitigate infection rates.
methodsWe conducted a three-phase prospective intervention in two intensive care units of Xiangya Hospital over six months (January through June 2019, with every two months being a phase), involving 776 diarrhea patients and 72 cases of hospital-onset C. difficile infection (HO-CDI). The primary outcome was the change in HO-CDI incidence, defined as the number of confirmed HO-CDI cases per 10,000 ICU days. Secondary outcomes included the proportion of patients with diarrhea who had HO-CDI, improvements in healthcare workers’ knowledge, attitudes, and practices (KAP) regarding CDI, as well as changes in antimicrobial use. We created a C. difficile infection prevention and control knowledge questionnaire and surveyed all healthcare workers before and after the training for the correctness of each question, and the pre- and post-intervention questionnaires assessed knowledge of CDI prevention. Antimicrobial usage was tracked across the three phases.
resultsThe proportion of patients with diarrhea who had HO-CDI in three phases (13.3%vs.8.79%vs.6.5%, P = 0.032) and the the incidence of HO-CDI per 10,000 ICU patient-days (117 vs. 99 vs. 72, P = 0.018) both showed a significant downward trend. After the training, the correctness of the healthcare workers’ questionnaire on knowledge, attitudes and practices (KAP) improved significantly (P = 0.002). Among all patients, there was a decline in the DDD (Define Daily Dosing) / 1000 patient-days of third-generation cephalosporin (212 vs. 185 vs. 172, P < 0.001).
conclusionsThe multi-faceted intervention effectively reduced Clostridium difficile infection (CDI) rates in the ICU setting. This highlights the importance of combining antimicrobial stewardship, healthcare worker training, and infection control measures.
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