title: National European guidelines for the prevention of Clostridium difficile infection: a systematic qualitative review.
abstract: BACKGROUND
  Clostridium difficile is the most frequent infectious cause of nosocomial diarrhoea and a major topic in infection prevention.
  
  
  OBJECTIVE
  To overview current national European guidelines for C. difficile infection (CDI) prevention and review the recommendations in respect of their evidence base and conformity to each other and the European Centre for Disease Control and Prevention (ECDC) guidance.
  
  
  METHODS
  In 34 European countries, the ECDC healthcare-associated infection (HCAI) surveillance National Contact Points and other HCAI experts (NCPs) were invited to complete an online questionnaire and to supply their guidelines. Guidelines not available in English, French or German were translated into English. For the qualitative analysis, a matrix with key measures based on the 2008 ECDC guidance was established. The review process was conducted independently by two reviewers.
  
  
  RESULTS
  All 34 NCPs responded to the questionnaire and supplied 15 guidelines in total. Six of 34 (18%) countries reported having used the ECDC guidance as a basis for the development or revision of their national guideline. There was wide variation in the scope and detailing. Only six of the documents and the ECDC guidance supplied a rating for the strength of recommendations. The rating systems varied in how the categories were defined. Furthermore, the stated strength for similar measures varied across different guidelines.
  
  
  CONCLUSIONS
  The ECDC guidance has not yet had a strong influence on the development or revision of national CDI prevention guidelines. One possible explanation for the variations is the necessity to adapt recommendations to national conditions. The use of internationally recognized instruments for the development of guidelines could help to improve their quality. Recommendations about monitoring or auditing the implementation would make them more useful.
authors: University Medical Center Freiburg, Department of Environmental Health Sciences, Division of Infection Control and Hospital Epidemiology, Freiburg, Germany. Electronic address: maria.martin@slk-kliniken.de.
authors: M
authors: M
authors: Martin
authors: University of Geneva Hospitals, Infection Control Programme, Geneva, Switzerland.
authors: W
authors: W
authors: Zingg
authors: University Medical Center Freiburg, Department of Environmental Health Sciences, Division of Infection Control and Hospital Epidemiology, Freiburg, Germany.
authors: E
authors: E
authors: Knoll
authors: University Medical Center Freiburg, Department of Environmental Health Sciences, Division of Infection Control and Hospital Epidemiology, Freiburg, Germany.
authors: C
authors: C
authors: Wilson
authors: University Medical Center Freiburg, Department of Environmental Health Sciences, Division of Infection Control and Hospital Epidemiology, Freiburg, Germany.
authors: M
authors: M
authors: Dettenkofer
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D003430:Cross-Sectional Studies; D003967:Diarrhea / Q000453:epidemiology / Q000382:microbiology / Q000517:prevention & control*; D005060:Europe / Q000453:epidemiology; D019983:Guideline Adherence; D006291:Health Policy; D006302:Health Services Research; D006801:Humans; D017053:Infection Control / Q000379:methods*; D011795:Surveys and Questionnaires
keywords: Clostridium difficile infection; Europe; Guidelines; Healthcare-associated infection; Infection prevention; Recommendations