Clostridium difficile-associated disease: how much do we really know? A single institution study
Hedley S. Roth A B , Christopher T. Parker A , Roger J. Wale A and Satish K. Warrier AA Department of Colorectal Surgery, Alfred Health, Prahran, Vic. 3181, Australia.
B Corresponding author. Email: h.roth@alfred.org.au
Healthcare Infection 19(4) 122-127 https://doi.org/10.1071/HI14031
Submitted: 23 February 2014 Accepted: 2 October 2014 Published: 26 November 2014
Abstract
Introduction: Clostridium difficile (C. difficile) is the most common cause of antibiotic-related diarrhoea. In the immunocompromised host it is a source of considerable morbidity. Transmission between patients is preventable. The aim of this study was to survey healthcare professionals’ knowledge of Clostridium difficile infection (CDI) at our institution.
Methods: A written survey was distributed to doctors and nurses of a major tertiary institution. The survey polled knowledge and management decisions regarding clinical scenarios relating to C. Difficile-associated disease and transmission. Survey responses were collated and analysed.
Results: One hundred and forty-six healthcare professionals (91.3%) completed the survey (81 nurses, 65 doctors). Thirty-two (21.9%) had attended an educational seminar on C. difficile. No healthcare worker was able to correctly answer all survey questions. Only four (2.7%) respondents correctly identified all major risk factors for CDI. Respondents who had previously attended a CDI information session were more likely to identify broad-spectrum antibiotic use as a risk factor (97% v. 82%, P = 0.046), and more likely to be aware of the existence of CDI in the community setting (97% v. 78%, P = 0.02). Thirty-four (23.3%) respondents identified the most important management aspects in non-severe CDI, while 85 (58.2%) identified the best method to remove C. difficile spores. Doctors were less likely to identify the correct method of preventing the transmission of the spore-form of C. difficile than nurses (49% v. 69%, P = 0.04). Overall survey performance was better among employees who had attended an information session regarding CDI, (63.1% v. 56.7%, P < 0.01).
Conclusions: Knowledge of CDI is poor among healthcare professionals. A potential for further education exists.
References
[1] Bartlett JG, Moon N, Chang TW, Taylor N, Onderdonk AB. Role of Clostridium difficile in antibiotic -associated pseudomembranous colitis. Gastroenterology 1978; 75 778–82.| 1:STN:280:DyaE1M%2FisFCnsQ%3D%3D&md5=50bbba958dfa1551e758b4d080f5784fCAS | 700321PubMed |
[2] Pittet D. Compliance with hand disinfection and its impact on hospital-acquired infections. J Hosp Infect 2001; 48 S40–6.
| Compliance with hand disinfection and its impact on hospital-acquired infections.Crossref | GoogleScholarGoogle Scholar | 11759025PubMed |
[3] Janka J, O’Grady NP. Clostridium difficile infection: current perspectives. Curr Opin Crit Care 2009; 15 149–53.
| Clostridium difficile infection: current perspectives.Crossref | GoogleScholarGoogle Scholar | 19578325PubMed |
[4] Barbut F, Jones G, Eckert C. Epidemiology and control of Clostridium difficile infections in healthcare settings: an update. Curr Opin Infect Dis 2011; 24 370–6.
| Epidemiology and control of Clostridium difficile infections in healthcare settings: an update.Crossref | GoogleScholarGoogle Scholar | 21505332PubMed |
[5] Dial S, Alrasadi K, Manoukian C, Huang A, Menzies D. Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies. CMAJ 2004; 171 33–8.
| Risk of Clostridium difficile diarrhea among hospital inpatients prescribed proton pump inhibitors: cohort and case-control studies.Crossref | GoogleScholarGoogle Scholar | 15238493PubMed |
[6] Dial S, Delaney JA, Barkun AN, Suissa S. Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease. JAMA 2005; 294 2989–95.
| Use of gastric acid-suppressive agents and the risk of community-acquired Clostridium difficile-associated disease.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXhtleltL7P&md5=f62d589d2c36724abaf02cca97157f90CAS | 16414946PubMed |
[7] Bliss DZ, Johnson S, Savik K, Clabots CR, Willard K, Gerding DN. Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding. Ann Intern Med 1998; 129 1012–9.
| Acquisition of Clostridium difficile and Clostridium difficile-associated diarrhea in hospitalized patients receiving tube feeding.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK1M%2FmsVynsA%3D%3D&md5=6fd937b6a42f159ea6fc61d6fed5690eCAS | 9867755PubMed |
[8] Hookman P, Barkin JS. Clostridium difficile associated infection, diarrhea and colitis. World J Gastroenterol 2009; 15 1554–80.
| Clostridium difficile associated infection, diarrhea and colitis.Crossref | GoogleScholarGoogle Scholar | 19340897PubMed |
[9] Blot E, Escande M-C, Besson D, Barbut F, Granpeix C, Asselain B, Falcou M-C, Pouillart P. Outbreak of Clostridium difficile-related diarrhoea in an adult oncology unit: risk factors and microbiological characteristics. J Hosp Infect 2003; 53 187–92.
| Outbreak of Clostridium difficile-related diarrhoea in an adult oncology unit: risk factors and microbiological characteristics.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DC%2BD3s7htVyqug%3D%3D&md5=2437712b1806737035fafdad90e948a6CAS | 12623319PubMed |
[10] Mitchell B, Ware C, McGregor A, Brown S, Wells A. Clostridium difficile infection in Tasmanian public hospitals 2006–2010. Healthc Infect 2011; 16 101–6.
| Clostridium difficile infection in Tasmanian public hospitals 2006–2010.Crossref | GoogleScholarGoogle Scholar |
[11] Warny M, Pepin J, Fang A, Killgore G, Thompson A, Brazier J, Frost E, McDonald LC. Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe. Lancet 2005; 366 1079–84.
| Toxin production by an emerging strain of Clostridium difficile associated with outbreaks of severe disease in North America and Europe.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2MXhtVartL3E&md5=b6c2ae359246707bbd674fc4a9590b70CAS | 16182895PubMed |
[12] Aroori S, Blencowe N, Pye G, West R. Clostridium Difficile: how much to hospital staff know about it? Ann R Coll Surg Engl 2009; 91 464–9.
| Clostridium Difficile: how much to hospital staff know about it?Crossref | GoogleScholarGoogle Scholar | 19558760PubMed |
[13] Fayerberg E, Bouchard J, Kellie SM. Knowledge, attitudes and practice regarding Clostridium difficile: a survey of physicians in an academic medical center. Am J Infect Control 2013; 41 266–9.
| Knowledge, attitudes and practice regarding Clostridium difficile: a survey of physicians in an academic medical center.Crossref | GoogleScholarGoogle Scholar | 22981165PubMed |
[14] Grayson L, Russo P, Cruickshank M, Bear J, Gee C, Hughes C, Johnson P, McCann R, McMillan A, Mitchell B, Selvey C, Smith R, Wilkinson I. Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative. Med J Aust 2011; 195 615–9.
| Outcomes from the first 2 years of the Australian National Hand Hygiene Initiative.Crossref | GoogleScholarGoogle Scholar |
[15] Stuart RL, Marshall C, McLaws M, Boardman C, Russo P, Harrington G, Ferguson J. ASID/AICA position statement – infection control guidelines for patients with Clostridium difficile infection in healthcare settings. Healthc Infect 2011; 16 33–9.
| ASID/AICA position statement – infection control guidelines for patients with Clostridium difficile infection in healthcare settings.Crossref | GoogleScholarGoogle Scholar |
[16] Pepin J, Valiquette L, Alary M-E, Villemure P, Pelletier A, Forget K, Pepin K, Chouinard D. Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity. CMAJ 2004; 171 466–72.
| Clostridium difficile-associated diarrhea in a region of Quebec from 1991 to 2003: a changing pattern of disease severity.Crossref | GoogleScholarGoogle Scholar | 15337727PubMed |
[17] Centers for Disease Control and Prevention (CDC) Severe Clostridium difficile-associated disease in populations previously at low risk: four states, 2005. MMWR Morb Mortal Wkly Rep 2005; 54 1201–5.
| 16319813PubMed |
[18] Valiquette L, Cossette B, Garant MP, Diab H, Pepin J. Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain. Clin Infect Dis 2007; 45 S112–21.
| Impact of a reduction in the use of high-risk antibiotics on the course of an epidemic of Clostridium difficile-associated disease caused by the hypervirulent NAP1/027 strain.Crossref | GoogleScholarGoogle Scholar | 1:CAS:528:DC%2BD2sXhtVKhu7zK&md5=ccc847f6105da9bfacfac0f220866554CAS | 17683015PubMed |
[19] Johnson S, Gerding DN, Olson MM, Weiler M, Hughes R, Clabots C, Peterson L. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990; 88 137–40.
| Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission.Crossref | GoogleScholarGoogle Scholar | 1:STN:280:DyaK3c7ksVOqsQ%3D%3D&md5=0812d93ac5075cf5ad7cd366c69ad004CAS | 2301439PubMed |
[20] Vonberg RP, Kuijper EJ, Wilcox MH, Barbut F, Tüll P, Gastmeier P, Van Den Broek P, Colville A, Coignard B, Daha T, Debast S, Duerden B, Van Den Hof S, Van Der Kooi T, Maarleveld H, Nagy E, Notermans D, O’Driscoll J, Patel B, Stone S, Wiuff C. Infection control measures to limit the spread of Clostridium difficile. Clin Microbiol Infect 2008; 14 2–20.
| Infection control measures to limit the spread of Clostridium difficile.Crossref | GoogleScholarGoogle Scholar | 18412710PubMed |