W5 RUA

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Carling, P. C., O’Hara, L. M., Harris, A. D., & Olmsted, R. (2023). Mitigating hospital-onset Clostridioides difficile: The impact of an optimized environmental hygiene program in eight hospitals. Infection Control & Hospital Epidemiology, 44(3), 440–446. https://doi.org/10.1017/ice.2022.84

Mitigating hospital-onset Clostridioides difficile: The impact of an optimized environmental hygiene program in eight hospitals - Chamberlain University

Purpose: To evaluate the effects of an optimized hospital-wide environmental hygiene program using daily sporicidal disinfectant cleaning on hospital-onset Clostridioides difficile infection (HO-CDI) standardized infection ratios (SIRs). Hypothesis: Implementing standardized, validated daily sporicidal patient-zone cleaning and optimizing thoroughness of disinfection cleaning (TDC) would lead to a sustained reduction in HO-CDI rates. Study Question: Does a standardized environmental hygiene intervention decrease HO-CDI SIRs across multiple hospitals compared to control hospitals that do not implement the program?

Independent Variable: Environmental hygiene intervention involving daily sporicidal disinfectant cleaning and performance-feedback optimization of cleaning thoroughness. Dependent Variable: Hospital-onset C. difficile infection standardized infection ratios (HO-CDI SIRs) and thoroughness of disinfection cleaning (TDC).

Multi-site quasi-experimental study with control hospitals and a nonequivalent dependent variable.

Eight acute-care hospitals located in six U.S. states with stable endemic HO-CDI rates during the 18-month pre-intervention period.

HO-CDI SIRs were measured quarterly using NHSN surveillance data. Thoroughness of cleaning was monitored prospectively using validated fluorescent marker assessments. Difference-in-differences analysis measured changes relative to control hospitals.

After implementation and optimization of cleaning quality, TDC increased to 93.6% across sites. HO-CDI SIR decreased from 1.03 to 0.6 (P = .009). Adjusted difference-in-differences showed a 0.55 absolute reduction in HO-CDI SIR (P < .001), representing a 50% relative decrease compared to controls. The environmental hygiene intervention produced sustained reductions in HO-CDI.

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Durant, D. J., Willis, L., & Duvall, S. (2020). Adoption of electronic hand hygiene monitoring systems in New York State hospitals and the associated impact on hospital-acquired C. difficile infection rates. American Journal of Infection Control, 48(7), 733–739. https://doi.org/10.1016/j.ajic.2020.04.005

Purpose: To explore the adoption of electronic HH monitoring systems (EHHMS) in New York State hospitals and assess their impact on C. difficile infection rates. Hypothesis: Adoption of EHHMS improves HH compliance and decreases hospital-acquired C. difficile infections (HA-CDI). Study Question: How does the adoption of EHHMS affect HH compliance and HA-CDI rates among New York State hospitals?

Independent Variable: Adoption of EHHMS. Dependent Variables: HH compliance rates and HA-CDI rates. Confounding Variable: Organizational HH culture.

Mixed-method study combining quantitative trend analysis and qualitative interviews

56 acute care hospitals (30% of total hospitals in New York State). Convenience sample based on survey participation.

Data collected through hospital surveys, trend analysis of HA-CDI rates, and interviews with infection prevention teams.

EHHMS adoption was low (2/56 hospitals). Hospitals with EHHMS showed 20–30% increase in HH compliance and up to 70% decrease in HA-CDI rates initially, but improvements were not sustained. Strong HH culture was identified as critical for long-term compliance and infection reduction.

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