Investigating the relationship between vancomycin-resistant Enterococcus control practices and the incidence of health care-associated Clostridioides difficile infections in Ontario

Rebecca Ling; Camille Achonu; Ye Li; Kevin C Katz; Gary Garber; Jennie Johnstone

doi:10.1016/j.ajic.2019.08.021

Investigating the relationship between vancomycin-resistant Enterococcus control practices and the incidence of health care-associated Clostridioides difficile infections in Ontario

Am J Infect Control. 2020 Mar;48(3):324-326. doi: 10.1016/j.ajic.2019.08.021. Epub 2019 Sep 21.

Authors

Rebecca Ling¹, Camille Achonu², Ye Li¹, Kevin C Katz³, Gary Garber⁴, Jennie Johnstone⁵

Affiliations

¹ Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada.
² Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada.
³ North York General Hospital, Toronto, Ontario, Canada; Department of Laboratory Medicine and Pathobiology, University of Toronto, Toronto, Ontario, Canada.
⁴ Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
⁵ Infection Prevention and Control, Public Health Ontario, Toronto, Ontario, Canada; Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada; Department of Medicine, University of Toronto, Toronto, Ontario, Canada. Electronic address: jennie.johnstone@oahpp.ca.

PMID: 31551123
DOI: 10.1016/j.ajic.2019.08.021

Abstract

We evaluated the impact of discontinuing vancomycin-resistant Enterococcus (VRE) screening and use of contact precautions on the incidence of health care-associated Clostridioides difficile infection (HA-CDI) in acute teaching hospitals in Ontario, Canada. Among hospitals that stopped VRE screening and contact precaution measures, there was a significant change in HA-CDI rates after the discontinuation of practices (incidence rate ratios, 1.11; 95% confidence interval, 1.01-1.22). No change in rate was observed among hospitals that continued VRE control practices. Screening and use of contact precautions for VRE may provide hospitals additional advantages for broadened HA-CDI control and prevention.

Keywords: Health care–associated infection; Infection control practice; Quasi-experimental design.

MeSH terms

Clostridioides / pathogenicity
Clostridium Infections / etiology*
Clostridium Infections / microbiology*
Cross Infection / etiology*
Cross Infection / microbiology
Delivery of Health Care
Gram-Positive Bacterial Infections / prevention & control*
Health Facilities
Hospitals
Humans
Incidence
Infection Control / statistics & numerical data*
Ontario
Vancomycin / pharmacology
Vancomycin-Resistant Enterococci / drug effects
Vancomycin-Resistant Enterococci / pathogenicity*

Substances

Vancomycin