title: Analysis of interventions to reduce the incidence of Clostridium difficile infection at a London teaching hospital trust, 2003-2011.
abstract: BACKGROUND
  Since 2008 there has been a substantial fall in the incidence of Clostridium difficile infection (CDI) in the UK, though it is unclear what contribution local and governmental interventions have made to this reduction.
  
  
  OBJECTIVE
  To assess the value of retrospective analysis using a segmented regression model and single factor analysis of variance (ANOVA) in assessing the impact of interventions to reduce hospital-acquired CDI.
  
  
  METHODS
  A retrospective time-series analysis of 28 interventions implemented over an eight-year period by a large teaching hospital trust. Single factor ANOVA was used to analyse the association between CDI rates and changes in antibiotic usage and hand hygiene compliance data.
  
  
  RESULTS
  Whereas several interventions were associated with a reduction in CDI rates, insufficient time-points were available between interventions to allow meaningful interpretation of all the data. Reduction of cephalosporin and quinolone use was associated with reduction in CDI rates. There was little association between observed variations in hand hygiene compliance and CDI rates.
  
  
  CONCLUSIONS
  Though several interventions were associated with a reduction in CDI, this study illustrates the inherent limitations of retrospective time-series methodology for the investigation of infection control measures where large numbers of interventions are introduced over a short time-period. Single factor ANOVA demonstrated an association between fall in CDI and restriction of high-risk antibiotic use. Little association was demonstrated between compliance rates documented in hand hygiene audits and CDI, though compliance was relatively high throughout the period of study.
authors.affiliation: Department of Medical Microbiology, King's College Hospital, London, UK.
authors.forename: O
authors.initials: O
authors.lastname: Marufu
authors.affiliation: Department of Medical Microbiology, King's College Hospital, London, UK.
authors.forename: N
authors.initials: N
authors.lastname: Desai
authors.affiliation: Cranfield University, Cranfield, Bedford, UK.
authors.forename: D
authors.initials: D
authors.lastname: Aldred
authors.affiliation: Cranfield University, Cranfield, Bedford, UK.
authors.forename: T
authors.initials: T
authors.lastname: Brown
authors.affiliation: Department of Medical Microbiology, King's College Hospital, London, UK. Electronic address: i.eltringham@nhs.net.
authors.forename: I
authors.initials: I
authors.lastname: Eltringham
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002648:Child; D002675:Child, Preschool; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D003967:Diarrhea / Q000453:epidemiology* / Q000382:microbiology / Q000517:prevention & control*; D004363:Drug Utilization; D005260:Female; D063373:Hand Hygiene; D006302:Health Services Research; D006784:Hospitals, Teaching; D006801:Humans; D015994:Incidence; D017053:Infection Control / Q000379:methods*; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: Clostridium difficile infection; High-risk antibiotics; Infection control interventions