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IDM Master's Defense

Vatsala Rangachar Srinivasa - MPH MIC '18: Clostridium difficile infection spread within...

Monday 4/9 7:30AM - 8:30PM

Clostridium difficile infection spread within the hospital environment

Background: Clostridium difficile Infection (CDI) is one of the leading causes of hospital-associated infections (HAIs) accounting for nearly half a million infections in the United States (2015). It was associated with approximately 29,000 deaths nationwide in 2011. This study focusses on the role of environment in the spread of CDI within the hospital environment in a non-outbreak setting.

Method: The study was conducted at a 495- bed academic University-affiliated single center. The first step includes the performance of bed tracing on all positive CDI admitted patients in the year 2016. The second step included the collection of environmental cultures of the immediate patient surrounding shared devices and floors to identify lapses in environmental cleaning. Aerobic environmental culture was performed for CDI followed by Gram stain and anaerobic confirmatory culture. Both biochemical and molecular testing was used to confirm Clostridium difficile (CD) presence. 

Results: Bed tracing was performed for 115 hospital-associated (HA)- and 96 community-associated (CA)- CDI patients. Initial analysis between HA-CDI and CA-CDI revealed that the length of stay was significantly longer in HAIs. However, readmission and recurrence were significantly higher in CAIs. Bed-tracing showed a limited list of high burden rooms. Environmental Cultures revealed only 2 out of 81 rooms, 19 out of 28 floors & 3 out of 20 wheelchairs as positive for CD spores. None of these patients’ rooms had active CDI patients. 

Conclusion: Bed tracing is an important public health tool for recognizing rooms with high density of CDI. This is particularly important in outbreak settings or any increase in incidence. Environmental cultures for CD is the next logic step following bed-tracing results. Shared devices (such as wheel chairs) and floors of patients’ rooms could serve as a reservoir for CD spores. Routine monitoring of adequacy of disinfection of shared devices and floors is an important step to assure safe patient environment.

Advisor: Lawrence Kingsley

Last Updated On Thursday, April 5, 2018 by Abby Kincaid
Created On Thursday, April 5, 2018

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