According to a recent study by the University of Utah, one of the leading causes of healthcare-associated infections (HAIs), Clostridium difficile (C difficile), may spread more widely in intensive care units (ICUs) than what previous research suggested. The research highlights the need for infection prevention professionals to reevaluate existing methodology, especially due to C difficile accounting for 223,000 hospitalizations and 12,800 deaths annually in the US alone.
Featured in JAMA Network Open, the study utilized genomic analysis of C difficile isolates collected from two ICUs in Utah during 2018. The goal was to calculate rates and describe the transmission dynamics of C difficile across the ICUs. Apart from analyzing patient samples, researchers for the first time included samples from healthcare provider’s hands and the hospital environment to understand better how this pathogen navigates between patients and hospital surfaces.
Findings indicated that nearly 8% of admitted patients had C difficile that was genetically linked to another patient’s strain. This finding shows a threefold higher movement of the pathogen when compared to relying solely on patient sampling for studies. Senior study author Michael Rubin, MD, PhD, emphasized, ‘There’s a lot going on under the hood that we’re just not seeing.’
Comprehensive data was collected during a 13-week span, including daily samples from patient body sites, patient room surfaces, and hands or gloves of healthcare professionals taking care of the patient. Genomic sequencing was conducted on the collected samples.
Notably, the study also included nontoxigenic C difficile strains that are generally not considered while conducting most surveillance studies, as they usually aren’t associated with infections. More than 7,000 samples across 278 unique ICU admits were collected, from which 178 C difficile isolates were recovered, including patient body sites, patient rooms, shared environmental surfaces, and healthcare provider hands.
Results from the detailed genomic analysis revealed seven transmission clusters involving 22 (7.7%) of 287 occupant stays. Notably, five of these transmission clusters, about 71.4% would’ve been missed without additional sampling from environmental surfaces and healthcare provider hands. This finding indicates a potential shortcoming in the existing surveillance system and infection prevention techniques. It appears that the extend of C difficile transmission in ICUs has been underestimated by previous studies.
The research conveys a critical message for healthcare providers to prioritize and adhere to more stringent infection prevention measures to contain the spread of C difficile, particularly the toxigenic strain. Future similar studies need to incorporate an expanded scope, including multiple touchpoints within the ICU environment for a more comprehensive understanding of infection transmission dynamics.
Source: https://www.cidrap.umn.edu/clostridium-difficile/study-highlights-hidden-spread-c-diff-icus