title: Clostridium Difficile Infection in Acute Care Hospitals: Systematic Review and Best Practices for Prevention.
abstract: OBJECTIVE Prevention of Clostridium difficile infection (CDI) in acute-care hospitals is a priority for hospitals and clinicians. We performed a qualitative systematic review to update the evidence on interventions to prevent CDI published since 2009. DESIGN We searched Ovid, MEDLINE, EMBASE, The Cochrane Library, CINAHL, the ISI Web of Knowledge, and grey literature databases from January 1, 2009 to August 1, 2015. SETTING We included studies performed in acute-care hospitals. PATIENTS OR PARTICIPANTS We included studies conducted on hospitalized patients that investigated the impact of specific interventions on CDI rates. INTERVENTIONS We used the QI-Minimum Quality Criteria Set (QI-MQCS) to assess the quality of included studies. Interventions were grouped thematically: environmental disinfection, antimicrobial stewardship, hand hygiene, chlorhexidine bathing, probiotics, bundled approaches, and others. A meta-analysis was performed when possible. RESULTS Of 3,236 articles screened, 261 met the criteria for full-text review and 46 studies were ultimately included. The average quality rating was 82% according to the QI-MQCS. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products. Bundled interventions and antimicrobial stewardship showed promise for reducing CDI rates. Chlorhexidine bathing and intensified hand-hygiene practices were not effective for reducing CDI rates. CONCLUSIONS Daily and terminal cleaning of patient rooms using chlorine-based products were most effective in reducing CDI rates in hospitals. Further studies are needed to identify the components of bundled interventions that reduce CDI rates. Infect Control Hosp Epidemiol 2017;38:476-482.
authors.affiliation: 1Center for Behavioral Cardiovascular Health,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: Irene K
authors.initials: IK
authors.lastname: Louh
authors.affiliation: 3Division of Infectious Diseases,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: William G
authors.initials: WG
authors.lastname: Greendyke
authors.affiliation: 4Division of General Medicine,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: Emilia A
authors.initials: EA
authors.lastname: Hermann
authors.affiliation: 1Center for Behavioral Cardiovascular Health,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: Karina W
authors.initials: KW
authors.lastname: Davidson
authors.affiliation: 1Center for Behavioral Cardiovascular Health,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: Louise
authors.initials: L
authors.lastname: Falzon
authors.affiliation: 5New York-Presbyterian Hospital,New York,New York.
authors.forename: David K
authors.initials: DK
authors.lastname: Vawdrey
authors.affiliation: 7Department of Psychology,University of Colorado Denver,Denver,Colorado.
authors.forename: Jonathan A
authors.initials: JA
authors.lastname: Shaffer
authors.affiliation: 5New York-Presbyterian Hospital,New York,New York.
authors.forename: David P
authors.initials: DP
authors.lastname: Calfee
authors.affiliation: 3Division of Infectious Diseases,Department of Medicine,Columbia University College of Physicians and Surgeons,New York,New York.
authors.forename: E Yoko
authors.initials: EY
authors.lastname: Furuya
authors.affiliation: 5New York-Presbyterian Hospital,New York,New York.
authors.forename: Henry H
authors.initials: HH
authors.lastname: Ting
mesh_terms: D000073602:Antimicrobial Stewardship; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000517:prevention & control* / Q000635:transmission; D004203:Disinfection; D004865:Equipment and Supplies, Hospital / Q000382:microbiology; D050456:Fomites / Q000382:microbiology; D006761:Hospitals; D006801:Humans; D017053:Infection Control / Q000379:methods*; D064872:Patient Care Bundles; D010362:Patients' Rooms