Clostridioides difficile Module 3 Evidence-tabel

Hacek (2010)

Type of study: Uncontrolled before-after intervention study

Setting and country:
- Hospital, United States
- CDI Clostridioides difficile-infectie (Clostridioides difficile-infectie ): high endemic level

Funding and conflicts of interest: None reported

Inclusion criteria:
None reported

Exclusion criteria:
None reported

N total:
Hospitals: n=3
Beds: n=850

Important prognostic factors:
No concurrent changes in:
- Routine daily cleaning/disinfection of CDI patient rooms (QAC)
- Contact precautions for CDI patients
- Hand hygiene procedures
- Antibiotic formulary
- Diagnostic CDI test (toxin A/B stool test)

Concurrent changes unknown for:
- Patient population
- Indication for diagnostic CDI test not reported

Terminal cleaning/disinfection of CDI patient rooms with a 10% (5,000 ppm) sodium hypochlorite solution (SHS)

NB. Walls added to the list of items to be cleaned

Terminal cleaning/disinfection of CDI patient rooms with a quaternary ammonium compound (QAC)

Length of follow-up:
QAC: 10 months
SHS: 24 months

Loss-to-follow-up:
Not reported / not applicable

Incomplete outcome data:
Not reported / not applicable

Healthcare-associated CDI:
PRR: 0.52 (95% CI: 0.42 to 0.64), in favour of 10% sodium hypochlorite solution

The implementation of a thorough, all-surface terminal bleach cleaning program in the rooms of patients with CDI has made a sustained, significant impact on reducing the rate of nosocomial CDI in our health care system.

Uncontrolled before-after study; no interrupted time series analysis (potential bias due to concurrent changes in patient population, cleaning practices, infection control practices, diagnostic practices, or treatment practices).
- Concurrent changes in patient population not reported.
- No adjustment for confounding factors.
- Concurrent implementation EVS notification of CDI discharges, EVS reminders of terminal cleaning procedures and cleaning observations.
- Indication for C. difficile toxin stool test not reported, nor whether this was comparable for both study periods.

Number of CDIs , total number of admissions or patient days not reported.

Compliance data for terminal cleaning/disinfection not reported.

Prevalent cases; unclear whether prevalent cases at time of implementation of the intervention were excluded from the study population after implementation. Potential underestimation of the effect on intervention is expected to be minimal considering the duration of follow-up.