Impact of targeted interventions on healthcare-acquired infection prevention and control of Clostridium difficile infections

Abstract

Background: Clostridium 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. Methods: We 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. Results: The 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). Conclusions: The 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.