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Ellie J. C. Goldstein, Stuart Johnson, Pierre-Jean Maziade, Lynne V. McFarland, William Trick, Linda Dresser, Mathieu Millette, Hadi Mazloum, Donald E. Low, Pathway to Prevention of Nosocomial Clostridium difficile Infection, Clinical Infectious Diseases, Volume 60, Issue suppl_2, May 2015, Pages S148–S158, https://doi.org/10.1093/cid/civ142
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Abstract
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.
