Clostridium difficile outbreak: Epidemiological surveillance, infection prevention and control

Introduction. Clostridium difficile infection (CDI) is currently considered the most common cause of health care-associated infections. The aim is to describe the trend of CDI in an Italian hospital and to assess the efficacy of the measures adopted to manage the burden. Methods. Data were retrieved in the San Salvatore Hospital of L’Aquila, from 1 January 2016 to 31 December 2018. Incidence rate of CDIs was calculated as the number of new infected persons per 10,000 patient-days. Changes in the CDI rate during the period considered were analysed using a Joinpoint regression model and related to the preventive strategies adopted. The strategies adopted focused mainly on patient isolation, reinforcement of proper hand hygiene techniques, antimicrobial stewardship and environmental disinfection. Results. CDI/10,000 patient-days was 6.27 in 2016 and increased to 7.71 in 2017, then drastically decreased to 2.76 during 2018. The Joinpoint regression analysis identified three Joinpoints: Sep-2016, Jan-2017, and Sep-2017. There was a reduction from 2016/01 to 2016/09 (slope = -1.44; p = 0.67), then there was an increase from September 2016 to February 2017 (slope = 30.01; p = 0.29), both statistically not significant. Therefore, there was an important decrement from February 2017 to September 2017, statistically significant (slope = -15.84; p = 0.012). Conclusions. Reports based on routine laboratory data can accurately measure population burden of CDI with limited surveillance resources. The adoption of multi-pronged strategies has proven effective in reducing CDI. It’s important to keep attention high regarding preventive measures of CDI, also a continuous joint effort by all health professionals, caregivers and patients is needed.