Hospital management of Clostridium difficile infection: a review of the literature.
BACKGROUND
The emergence of the epidemic Clostridium difficile 027 strain has renewed interest in infection control practices.


OBJECTIVE
To review the effectiveness of different practices to reduce hospital C. difficile infection (CDI) in non-outbreak settings.


METHODS
Data sources were identified by a MEDLINE search in English and French. The ORION statement was used to extract key data from articles describing interventions to manage CDI.


RESULTS
Twenty-one studies, published between 1982 and December 2013, were reviewed. Most studies were before-after interventions, and a few studies were planned, formal, prospective investigations. The effects of the following single or combined interventions were described: antibiotic management; environmental disinfection and/or cleaning; hand hygiene; bathing; surveillance; cohorting; and isolation of infected patients in private rooms.


CONCLUSIONS
With many methodological weaknesses and some inadequate research reporting, the observed reduction in CDI may not be entirely attributable to interventions. Although infection control programmes involving education and handwashing/gloving protocols were found to have contributed to a reduction in the incidence of CDI, these measures were usually a component of multi-faceted interventions that did not provide for evaluation of the relative impact of each factor. Appropriate environmental disinfection and antibiotic stewardship would appear to offer the most effective benefits.
Epidemiology and Public Health Department, University of Lyon, Lyon, France; Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils of Lyon, Lyon, France. Electronic address: naghamkhanafer@hotmail.com.
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Khanafer
Epidemiology and Public Health Department, University of Lyon, Lyon, France; Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils of Lyon, Lyon, France.
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Voirin
Pierre and Marie Curie University, Paris, France; National Reference Laboratory for C. difficile, Saint Antoine Hospital, Paris, France.
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Barbut
Department of Medical Microbiology, LUMC, Leiden, The Netherlands.
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Kuijper
Epidemiology and Public Health Department, University of Lyon, Lyon, France; Epidemiology and Infection Control Unit, Edouard Herriot Hospital, Hospices Civils of Lyon, Lyon, France.
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Vanhems
D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D016360:Clostridioides difficile / Q000187:drug effects*; D003015:Clostridium Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000453:epidemiology / Q000517:prevention & control; D004203:Disinfection / Q000379:methods*; D005260:Female; D006235:Hand Disinfection; D006801:Humans; D017053:Infection Control / Q000379:methods*; D008297:Male; D011446:Prospective Studies
D000900:Anti-Bacterial Agents
Clostridium difficile infection; Effectiveness; Hospital; Intervention study; Management