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Retrospective Study: Reassessing Isolation Approach in Patients with CDI Infections

A retrospective analysis exploring the impact of isolation practices in patients experiencing Clostridioides difficile infection (CDI) has recently concluded in South Korea. Issues of patient room shortages and the ongoing pandemic have necessitated reevaluation of current isolation protocols. The study, conducted in a hospital where CDI patients were not isolated, unearthly valuable insight into the secondary transmission rate of CDI. Clostridioides difficile infections, particularly those acquired in healthcare facilities, pose a significant risk due to their high prevalence rates. While effective infection control measures have lowered the incidence of hospital-acquired CDI, the effectiveness of some specific interventions like patient isolation remains uncertain.

Data from a real-time locating system (RTLS) and electronic medical records were utilized in the research, enabling a thorough investigation of patients who had both direct and indirect contact with CDI index patients. The analysis sought to determine the secondary CDI transmission, identified by whole-genome sequencing. Among the recorded contact cases, two instances of secondary transmission were observed, one through direct contact and another through environmental sources.

The Yongin Severance Hospital, equipped with RTLS, served as the study location, providing high sensitivity epidemiologic data relating to patient contact time and distance. The study, which focused on contact time necessary for infection transmission in susceptible patients, was approved by the Yonsei University Health System Clinical Trial Centre, and the stipulations of the Declaration of Helsinki were strictly adhered to.

The retrospective cohort study involved hospitalized patients who had direct or indirect contact with diagnosed CDI patients over a four-month period from September to December 2021. Data from the last enrolled patient was pieced together by July 29, 2022. PCR was used to diagnose the CDI, and the progress of the subjects was monitored until their last outpatient visit or hospitalization.

The hospital, despite facing patient room shortages, adopted enhanced standard infection control measures in response to the COVID-19 pandemic. Such measures included regular handwashing with soap and water and mandatory mask use. The institution did not isolate CDI patients as a contact precaution during hospitalization.

Contact cases were tracked using three different methods, involving direct contact, indirect contact via healthcare personnel, and indirect contact through environmental contaminants. Contact duration was systematically calculated for the entire hospitalization period, regardless of the perceived contagiousness of the patients.

Researchers also performed PCR ribotyping for all C. difficile isolates obtained from patients diagnosed with CDI. The primary outcome was marked as secondary CDI transmission, determined through whole-genome sequencing. The sequences performed revealed that a low level of direct contact was required for secondary CDI transmission.

Findings of the study underscore the importance of exhaustively implementing standard preventive methods, including environmental decontamination. Their data suggests contact isolation of CDI patients may not be necessary in nonoutbreak settings. The study’s results could have significant implications on managing CDI patients, especially in resource-limited environments like hospitalized settings dealing with shortages of isolation rooms. Future research should be undertaken to replicate and verify these findings.

Source: https://wwwnc.cdc.gov/eid/article/30/5/23-1588

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