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Reducing C. difficile in children: An agent-based modeling approach to evaluate intervention effectiveness

Published online by Cambridge University Press:  13 February 2020

Anna K. Barker Open the ORCID record for Anna K. Barker [Opens in a new window] ,
Elizabeth Scaria ,
Oguzhan Alagoz ,
Ajay K. Sethi  and
Nasia Safdar
Anna K. Barker*
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Elizabeth Scaria
Affiliation:
Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
Oguzhan Alagoz
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin Department of Industrial and Systems Engineering, College of Engineering, University of Wisconsin-Madison, Madison, Wisconsin
Ajay K. Sethi
Affiliation:
Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin
Nasia Safdar
Affiliation:
Division of Infectious Diseases, Department of Medicine, School of Medicine and Public Health, University of Wisconsin-Madison, Madison, Wisconsin William S. Middleton Memorial Veterans Hospital, Madison, Wisconsin
*
Author for correspondence: Anna K. Barker, Email: baanna@med.umich.edu
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Abstract

Objective:

Clostridioides difficile infection (CDI) is rapidly increasing in children’s hospitals nationwide. Thus, we aimed to compare the effectiveness of 9 infection prevention interventions and 6 multiple-intervention bundles at reducing hospital-onset CDI and asymptomatic C. difficile colonization.

Design:

Agent-based simulation model of C. difficile transmission.

Setting:

Computer-simulated, 80-bed freestanding, tertiary-care pediatric hospital, including 8 identical wards with 10 single-bed patient rooms each.

Participants:

The model includes 5 distinct agent types: patients, visitors, caregivers, nurses, and physicians.

Interventions:

Daily and terminal environmental disinfection, screening at admission, reduced intrahospital patient transfers, healthcare worker (HCW), visitor, and patient hand hygiene, and HCW and visitor contact precautions.

Results:

The model predicted that daily environmental disinfection with sporicidal product, combined with screening for asymptomatic C. difficile at admission, was the most effective 2-pronged infection prevention bundle, reducing hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%. Single-intervention strategies, including daily disinfection, terminal disinfection, asymptomatic screening at admission, HCW hand hygiene, and patient hand hygiene, as well as decreasing intrahospital patient transfers, all also reduced both hospital-onset CDI and asymptomatic colonization in the model. Visitor hand hygiene and visitor and HCW contact precautions were not effective at reducing either measure.

Conclusions:

Hospitals can achieve substantial reduction in hospital-onset CDIs by implementing a small number of highly effective interventions.

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 41 , Issue 5 , May 2020 , pp. 522 - 530
Copyright
© 2020 by The Society for Healthcare Epidemiology of America. All rights reserved

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Footnotes

PREVIOUS PRESENTATION. An abstract of this study was presented as a poster at IDWeek 2018 on October 4, 2018, in San Francisco, California, and was included with the published conference proceedings: Barker, A, Scaria E, Alagoz, O, Sethi, A, Safdar, N. Clostridium difficile reduction: an agent-based simulation modeling approach to evaluating intervention comparative effectiveness at pediatric hospitals. Open Forum Infect Dis 2018;5:S197–S198.

References

Nylund, CM, Goudie, A, Garza, JM, Fairbrother, G, Cohen, MB. Clostridium difficile infection in hospitalized children in the United States. Arch Pediatr Adolesc Med 2011;165:451–457.CrossRefGoogle ScholarPubMed
Deshpande, A, Pant, C, Anderson, MP, Donskey, CJ, Sferra, TJ. Clostridium difficile infection in the hospitalized pediatric population: increasing trend in disease incidence. Pediatr Infect Dis J 2013;32:1138–1140.CrossRefGoogle ScholarPubMed
Rousseau, C, Poilane, I, De Pontual, L, Maherault, A-C, Le Monnier, A, Collignon, A. Clostridium difficile carriage in healthy infants in the community: a potential reservoir for pathogenic strains. Clin Infect Dis 2012;55:1209–1215.CrossRefGoogle ScholarPubMed
Adlerberth, I, Huang, H, Lindberg, E, et al. Toxin-producing Clostridium difficile strains as long-term gut colonizers in healthy infants. J Clin Microbiol 2014;52:173–179.CrossRefGoogle ScholarPubMed
Schutze, GE, Willoughby, RE, Committee on Infectious Diseases, et al. Clostridium difficile infection in infants and children. Pediatrics 2013;131:196–200.Google ScholarPubMed
Jangi, S, Lamont, JT. Asymptomatic colonization by Clostridium difficile in infants: implications for disease in later life. J Pediatr Gastroenterol Nutr 2010;51:2–7.CrossRefGoogle ScholarPubMed
Hecker, MT, Riggs, MM, Hoyen, CK, Lancioni, C, Donskey, CJ. Recurrent infection with epidemic Clostridium difficile in a peripartum woman whose infant was asymptomatically colonized with the same strain. Clin Infect Dis 2008;46:956–957.CrossRefGoogle Scholar
McLure, A, Clements, ACA, Kirk, M, Glass, K. Modelling diverse sources of Clostridium difficile in the community: importance of animals, infants and asymptomatic carriers. Epidemiol Infect 2019;147:e152. doi: 10.1017/S0950268819000384.CrossRefGoogle ScholarPubMed
Stoesser, N, Crook, DW, Fung, R, et al. Molecular epidemiology of Clostridium difficile strains in children compared with that of strains circulating in adults with Clostridium difficile–associated infection. J Clin Microbiol 2011;49:3994–3996.CrossRefGoogle ScholarPubMed
Yatsunenko, T, Rey, FE, Manary, MJ, et al. Human gut microbiome viewed across age and geography. Nature 2012;486:222–227.CrossRefGoogle ScholarPubMed
McFarland, LV, Ozen, M, Dinleyici, EC, Goh, S. Comparison of pediatric and adult antibiotic-associated diarrhea and Clostridium difficile infections. World J Gastroenterol 2016;22:3078–3104.CrossRefGoogle ScholarPubMed
McDonald, LC, Gerding, DN, Johnson, S, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis 2018;66:e1–e48.CrossRefGoogle Scholar
Gingras, G, Guertin, M-H, Laprise, J-F, Drolet, M, Brisson, M. Mathematical modeling of the transmission dynamics of Clostridium difficile infection and colonization in healthcare settings: a systematic review. PLoS One 2016;11:e0163880.CrossRefGoogle ScholarPubMed
Bonabeau, E. Agent-based modeling: methods and techniques for simulating human systems. Proc Natl Acad Sci U S A 2002;99:S7280–S7287.CrossRefGoogle ScholarPubMed
Barker, AK, Ngam, C, Musuuza, JS, Vaughn, VM, Safdar, N. Reducing Clostridium difficile in the inpatient setting: a systematic review of the adherence to and effectiveness of C. difficile prevention bundles. Infect Control Hosp Epidemiol 2017;38:639–650.CrossRefGoogle ScholarPubMed
Barker, AK, Alagoz, O, Safdar, N. Interventions to reduce the incidence of hospital-onset Clostridium difficile infection: an agent-based modeling approach to evaluate clinical effectiveness in adult acute care hospitals. Clin Infect Dis 2018;66:1192–1203.CrossRefGoogle ScholarPubMed
Rubin, MA, Jones, M, Leecaster, M, et al. A Simulation-based assessment of strategies to control Clostridium difficile transmission and infection. PLoS One 2013;8:e80671.CrossRefGoogle ScholarPubMed
Codella, J, Safdar, N, Heffernan, R, Alagoz, O. An agent-based simulation model for Clostridium difficile infection control. Med Decis Making 2015;35:211–229.CrossRefGoogle ScholarPubMed
American Hospital Association. AHA Hospital Statistics. Chicago: Healthcare InfoSource; 2016.Google Scholar
Friedman, ND, Pollard, J, Stupart, D, et al. Prevalence of Clostridium difficile colonization among healthcare workers. BMC Infect Dis 2013;13:459.CrossRefGoogle ScholarPubMed
Multidrug-resistant organism and Clostridium difficile infection (MDRO/CDI) module. Centers for Disease Control and Prevention website. https://www.cdc.gov/nhsn/pdfs/pscmanual/12pscmdro_cdadcurrent.pdf. Published January 2017. Accessed April 18, 2019.Google Scholar
Wilensky, U. Netlogo. Northwestern University Center for Connected Learning and Computer-Based Modeling, website. http://ccl.northwestern.edu/netlogo/. Published 1999. Accessed January 20, 2020.Google Scholar
Stout, NK, Goldie, SJ. Keeping the noise down: common random numbers for disease simulation modeling. Health Care Manag Sci 2008;11:399–406.CrossRefGoogle ScholarPubMed
Orenstein, R, Aronhalt, KC, McManus, JE, Fedraw, LA. A targeted strategy to wipe out Clostridium difficile . Infect Control Hosp Epidemiol 2011;32:1137–1139.CrossRefGoogle ScholarPubMed
Sitzlar, B, Deshpande, A, Fertelli, D, Kundrapu, S, Sethi, AK, Donskey, CJ. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol 2013;34:459–465.CrossRefGoogle ScholarPubMed
Goodman, ER, Platt, R, Bass, R, Onderdonk, AB, Yokoe, DS, Huang, SS. Impact of an environmental cleaning intervention on the presence of methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci on surfaces in intensive care unit rooms. Infect Control Hosp Epidemiol 2008;29:593–599.CrossRefGoogle ScholarPubMed
Hess, AS, Shardell, M, Johnson, JK, et al. A randomized, controlled trial of enhanced cleaning to reduce contamination of healthcare worker gowns and gloves with multidrug-resistant bacteria. Infect Control Hosp Epidemiol 2013;34:487–493.CrossRefGoogle ScholarPubMed
Moore, DL. Infection control in paediatric office settings. Paediatr Child Health 2008;13:408–419.CrossRefGoogle Scholar
Tabak, YP, Zilberberg, MD, Johannes, RS, Sun, X, McDonald, LC. Attributable burden of hospital-onset Clostridium difficile infection: a propensity score matching study. Infect Control Hosp Epidemiol 2013;34:588–596.CrossRefGoogle ScholarPubMed
Sammons, JS, Localio, R, Xiao, R, Coffin, SE, Zaoutis, T. Clostridium difficile infection is associated with increased risk of death and prolonged hospitalization in children. Clin Infect Dis 2013;57:1–8.CrossRefGoogle ScholarPubMed
Eyre, DW, Griffiths, D, Vaughan, A, et al. Asymptomatic Clostridium difficile colonisation and onward transmission. PLoS One 2013;8:e78445.CrossRefGoogle ScholarPubMed
Bobulsky, GS, Al-Nassir, WN, Riggs, MM, Sethi, AK, Donskey, CJ. Clostridium difficile skin contamination in patients with C. difficile–associated disease. Clin Infect Dis 2008;46:447–450.CrossRefGoogle ScholarPubMed
Longtin, Y, Paquet-Bolduc, B, Gilca, R, et al. Effect of detecting and isolating Clostridium difficile carriers at hospital admission on the incidence of C difficile infections: a quasi-experimental controlled study. JAMA Intern Med 2016;176:796–804.CrossRefGoogle ScholarPubMed
Abad, C, Fearday, A, Safdar, N. Adverse effects of isolation in hospitalised patients: a systematic review. J Hosp Infect 2010;76:97–102.CrossRefGoogle ScholarPubMed
Johnston, BC, Goldenberg, JZ, Vandvik, PO, Sun, X, Guyatt, GH. Probiotics for the prevention of pediatric antibiotic-associated diarrhea. Cochrane Database Syst Rev 2011;11:CD004827.Google Scholar
Yu, D, Lee, B, Newland, J, Goldman, J. Clostridium difficile infection rates in a children’s hospital with an antimicrobial stewardship program. Open Forum Infect Dis 2015;2:S1467.CrossRefGoogle Scholar
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