Effect of Detecting and Isolating Clostridium difficile Carriers at Hospital Admission on the Incidence of C difficile Infections: A Quasi-Experimental Controlled Study.
Clostridium difficile infection (CDI) is a major cause of health care-associated infection worldwide, and new preventive strategies are urgently needed. Current control measures do not target asymptomatic carriers, despite evidence that they can contaminate the hospital environment and health care workers' hands and potentially transmit C difficile to other patients.



To investigate the effect of detecting and isolating C difficile asymptomatic carriers at hospital admission on the incidence of health care-associated CDI (HA-CDI).



We performed a controlled quasi-experimental study between November 19, 2013, and March 7, 2015, in a Canadian acute care facility. Admission screening was conducted by detecting the tcdB gene by polymerase chain reaction on a rectal swab. Carriers were placed under contact isolation precautions during their hospitalization.



Changes in HA-CDI incidence level and trend during the intervention period (17 periods of 4 weeks each) were compared with the preintervention control period (120 periods of 4 weeks each) by segmented regression analysis and autoregressive integrated moving average (ARIMA) modeling. Concomitant changes in the aggregated HA-CDI incidence at other institutions in Québec City, Québec (n = 6) and the province of Québec (n = 94) were also examined.



Overall, 7599 of 8218 (92.5%) eligible patients were screened, among whom 368 (4.8%) were identified as C difficile carriers. During the intervention, 38 patients (3.0 per 10 000 patient-days) developed an HA-CDI compared with 416 patients (6.9 per 10 000 patient-days) during the preintervention control period (P < .001). There was no immediate change in the level of HA-CDIs on implementation (P = .92), but there was a significant decrease in trend over time of 7% per 4-week period (rate ratio, 0.93; 95% CI, 0.87-0.99 per period; P = .02). ARIMA modeling also detected a significant effect of the intervention, represented by a gradual progressive decrease in the HA-CDI time series by an overall magnitude of 7.2 HA-CDIs per 10 000 patient-days. We estimated that the intervention had prevented 63 of the 101 (62.4%) expected cases. By contrast, no significant decrease in HA-CDI rates occurred in the control groups.



Detecting and isolating C difficile carriers was associated with a significant decrease in the incidence of HA-CDI. If confirmed in subsequent studies, this strategy could help prevent HA-CDI.
Infection Prevention and Control Unit, Jewish General Hospital Sir Mortimer B. Davis, Montreal, Québec, Canada2Faculty of Medicine, McGill University, Montreal, Québec, Canada.
Yves
Y
Longtin
Infection Control Unit, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, Canada.
Bianka
B
Paquet-Bolduc
Institut National de Santé Publique du Québec, Québec City, Canada5Centre Hospitalier Universitaire de Québec, Québec City, Canada6Faculty of Medicine, Université Laval, Québec City, Québec, Canada.
Rodica
R
Gilca
Institut National de Santé Publique du Québec, Québec City, Canada7Centre de Recherche en Infectiologie de l'Université Laval, Québec City, Québec, Canada.
Christophe
C
Garenc
Institut National de Santé Publique du Québec, Québec City, Canada.
Elise
E
Fortin
Centre Hospitalier Universitaire de Québec, Québec City, Canada6Faculty of Medicine, Université Laval, Québec City, Québec, Canada7Centre de Recherche en Infectiologie de l'Université Laval, Québec City, Québec, Canada8Laboratoire de Santé Publique du Qué
Jean
J
Longtin
Centre Hospitalier Universitaire de Québec, Québec City, Canada6Faculty of Medicine, Université Laval, Québec City, Québec, Canada7Centre de Recherche en Infectiologie de l'Université Laval, Québec City, Québec, Canada9Department of Infectious Diseases, I.
Sylvie
S
Trottier
Centre Hospitalier Universitaire de Québec, Québec City, Canada6Faculty of Medicine, Université Laval, Québec City, Québec, Canada9Department of Infectious Diseases, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, Canada.
Philippe
P
Gervais
Centre Hospitalier Universitaire de Québec, Québec City, Canada6Faculty of Medicine, Université Laval, Québec City, Québec, Canada9Department of Infectious Diseases, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, Canada.
Jean-François
JF
Roussy
Laboratoire de Santé Publique du Québec, Institut National de Santé Publique du Québec, Sainte-Anne-de-Bellevue, Canada.
Simon
S
Lévesque
Infectious Diseases Unit, Chaim Sheba Medical Center, Tel HaShomer, Israel.
Debby
D
Ben-David
Department of Pharmacy, Institut Universitaire de Cardiologie et Pneumologie de Québec, Québec City, Canada.
Isabelle
I
Cloutier
Faculty of Medicine, McGill University, Montreal, Québec, Canada12Division of Infectious Diseases, McGill University Health Centre, Montreal, Québec, Canada.
Vivian G
VG
Loo
D002170:Canada / Q000453:epidemiology; D002353:Carrier State / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D016360:Clostridioides difficile / Q000235:genetics / Q000302:isolation & purification*; D003015:Clostridium Infections / Q000453:epidemiology / Q000382:microbiology* / Q000635:transmission; D003428:Cross Infection / Q000453:epidemiology / Q000235:genetics / Q000382:microbiology* / Q000635:transmission; D004196:Disease Outbreaks / Q000517:prevention & control*; D004636:Emergency Service, Hospital; D004761:Enterocolitis, Pseudomembranous; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D010343:Patient Admission / Q000706:statistics & numerical data; D011792:Quebec / Q000453:epidemiology; D012007:Rectum / Q000382:microbiology; D012189:Retrospective Studies