Pathway to Prevention of Nosocomial Clostridium difficile Infection.
BACKGROUND
To address the significant morbidity and mortality rates associated with nosocomial Clostridium difficile-associated diarrhea (CDAD), a series of recommendations and a pathway to prevention were developed.


METHODS
An expert panel of infectious disease (ID) specialists participated in a modified Delphi process with specific objectives: (1) conduct a review for CDAD and prevention; (2) develop statements based upon panel members' opinions; (3) hold a panel meeting during the 2012 IDWeek; and (4) review the final recommendations and prevention pathway prior to submission for publication.


RESULTS
The panel voted on (1) antibiotic stewardship (7 of 8 panelists); (2) reduction of other potentially modifiable risk factors (variable); (3) utilization of specific probiotics to prevent C. difficile overgrowth (8/8); (4) staff education regarding CDAD preventive measures (8/8); (5) appropriate hand hygiene for everyone (7/8); (6) environmental cleaning (8/8); (7) medical equipment disinfection (7/8); (8) early detection of CDAD in symptomatic patients (7/8); (9) usage of protective clothing/gloves (8/8); (10) proper measures during outbreak (8/8); and (11) surveillance to monitor efficacy data of preventive measures (8/8).


CONCLUSIONS
The panel members agreed with 11 of 17 recommendations presented. The additional recommendations by the panel were proton pump inhibitor use as a risk factor and the use of adjunctive therapy with specific probiotic, as it was approved by Health Canada for the risk reduction of CDAD in hospitalized patients.
RM Alden Research Laboratory and the David Geffen School of Medicine at UCLA, Los Angeles, California.
Ellie J C
EJ
Goldstein
Hines VA Hospital and Loyola University Medical Center, Chicago, Illinois.
Stuart
S
Johnson
Centre Hospitalier Pierre-Le Gardeur, Terrebonne, Quebec, Canada.
Pierre-Jean
PJ
Maziade
Department of Medicinal Chemistry, University of Washington, Seattle.
Lynne V
LV
McFarland
Collaborative Research Unit, Chicago, Illinois.
William
W
Trick
Leslie Dan Faculty of Pharmacy, University of Toronto, Ontario.
Linda
L
Dresser
Bio-K Plus International Inc, Laval, Quebec.
Mathieu
M
Millette
Bio-K Plus International Inc, Laval, Quebec.
Hadi
H
Mazloum
Mount Sinai Hospital, University of Toronto, Ontario, Canada.
Donald E
DE
Low
D002170:Canada / Q000453:epidemiology; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000517:prevention & control*; D003428:Cross Infection / Q000517:prevention & control*; D003697:Delphi Technique; D004203:Disinfection; D063373:Hand Hygiene; D006760:Hospitalization; D006801:Humans; D019936:Probiotics / Q000627:therapeutic use*; D054328:Proton Pump Inhibitors / Q000009:adverse effects; D012307:Risk Factors
D054328:Proton Pump Inhibitors
CDI; Clostridium difficile; prevention; probiotic