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

Carla Maria Dohrendorf; Steffen Unkel; Simone Scheithauer; Martin Kaase; Volker Meier; Diana Fenz; Jürgen Sasse; Manfred Wappler; Jutta Schweer-Herzig; Tim Friede; Utz Reichard; Helmut Eiffert; Roland Nau; Jana Seele

doi:10.1093/ageing/afab169

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

Age Ageing. 2021 Nov 10;50(6):2123-2132. doi: 10.1093/ageing/afab169.

Authors

Carla Maria Dohrendorf^{1

2}, Steffen Unkel³, Simone Scheithauer⁴, Martin Kaase⁴, Volker Meier⁵, Diana Fenz⁴, Jürgen Sasse⁶, Manfred Wappler⁷, Jutta Schweer-Herzig⁷, Tim Friede³, Utz Reichard⁸, Helmut Eiffert⁸, Roland Nau^{1

2}, Jana Seele^{1

2}

Affiliations

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.

PMID: 34473822
DOI: 10.1093/ageing/afab169

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.

Keywords: Clostridioides difficile infections; geriatric patients; interventional study; older people; probiotics; reduction of spores.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Clostridioides
Clostridioides difficile*
Clostridium Infections* / diagnosis
Clostridium Infections* / epidemiology
Cross Infection* / diagnosis
Cross Infection* / epidemiology
Cross Infection* / prevention & control
Cross-Over Studies
Humans
Quality Improvement