Occupying C. difficile-infected spaces associated with significant risk for infection

Individuals passing through hospital spaces “contaminated” with Clostridium difficile within the previous 24 hours were at a significantly increased risk for the infection, according to findings presented at the 2017 Society of Hospital Medicine annual meeting in Las Vegas.

Perspective from Saurabh Mehandru, MD

“Hospital-acquired C. difficile colitis is associated with increased length of stay and significant morbidity and mortality,” Sara G. Murray, MD, from the University of California, San Francisco, and colleagues wrote. “During hospitalization, patients visit many procedural, diagnostic and treatment areas throughout the hospital, presenting opportunities for spore contamination of surfaces and nosocomial disease transmission.”

Murray and colleagues mapped potential C. difficile transmission using electronic health record data of 86,648 hospitalizations between 2013 and 2015. There were 434,745 patient location changes during hospitalizations. They defined a space, such as a bed, a MRI machine or CT scanner in which a patient with a diagnosis of C. difficile has spent time as “contaminated,” regardless of real-world cleaning practices, for the following 24 hours. “Exposed” patients were defined as those who passed through contaminated locations. For 60 days, exposed and unexposed patients were followed for the acquisition of C. difficile. The disease was confirmed by a positive laboratory test, such as GDH and toxin immunoassay with or without confirmatory PCR. The researchers compared the ORs for C. difficile for exposed and unexposed individuals for each area of the hospital.

Results indicated that individuals exposed to C. difficile in the ED had a significantly increased risk for the infection within the next 60 days (OR = 2.7; P = 0.01) even when adjusting for age, gender, recent antibiotics, number of location changes and length of stay. Heat maps indicated that the potential concentration of the effect was located in the ED’s CT scanner. There was a significant association between C. difficile exposure in the ED’s CT scanner and disease development, according to adjusted analyses.

These results identify “an opportunity to improve cleaning practices in that location,” Murray and colleagues concluded. “Our novel data analytic strategy may be widely applicable for infection control quality improvement at other institutions and for other infectious diseases.” – by Alaina Tedesco

Reference:

Murray SG, et al. Spatial and temporal mapping of C. difficile: An exploratory big data analysis. Presented at: Society of Hospital Medicine Annual Meeting; May 1-4, 2017; Las Vegas.

Disclosure: Healio Internal Medicine was unable to confirm relevant financial disclosures at the time of publication.

Perspective

Saurabh Mehandru, MD

In line with improving quality of care metrics, there is increasing emphasis on reducing nosocomial infections. Among these, perhaps the most significant is hospital-acquired Clostridium difficile infection. In the recently published paper “Spatial and temporal mapping of C. difficile: An exploratory big data analysis,” Murray and co-workers from USCF used retrospective analyses of over 86,000 hospitalizations to map potential C. difficile transmission within the hospital. The authors conclude that getting a CT in the ED within 24 hours after a patient with C. difficile used the scanner was associated with increased odds of developing the disease in comparison to getting a CT when the scanner is not in the “contaminated” state.

Studies such as the present are important in the attempt to reduce nosocomial infection rates. However, the findings need to be interpreted with the following caveats. The retrospective nature of this study and multiple co-variables make it impossible to account for all the confounding factors. While it is entirely plausible that the use of a CT scanner in the ED following its use by a C. difficile-infected patient may enhance disease transmission, it is unclear why this is confined to the ED? Could this be related to the fact that ED patients may not have been diagnosed with C. difficile while hospitalized patients may be better characterized?

Regardless, this study does call for more carefully designed prospective analyses. Until such analyses are possible, universal decontamination procedures need to be carefully followed.

Saurabh Mehandru, MD

Assistant Professor of Gastroenterology

Icahn School of Medicine at Mount Sinai

Disclosures: Mehandru reports no relevant financial disclosures.

Society of Hospital Medicine Annual Meeting

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Occupying C. difficile-infected spaces associated with significant risk for infection

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