A comprehensive study revealed that a strategy designed by the Centers for Disease Control and Prevention (CDC) to prevent one of the most prevalent healthcare-associated infections in U.S. hospitals did not significantly reduce the incidence over time. This analysis, elucidated today in JAMA Network Open, was carried out in hospitals located in the southeastern part of the United States. The team of researchers, from both Duke University and the CDC, discovered that although hospitals that executed the strategy experienced a reduced occurrence of hospital-onset Clostridioides difficile infection (HO-CDI) compared to a control group of hospitals, the incidence was already on the decline in those facilities before the intervention and did not undergo any notable changes during the intervention period.
However, the researchers also highlighted that the COVID-19 pandemic may have influenced the results by hindering the full implementation of measures incorporated in the strategy. Initiated in 2018, the CDC’s Strategies to Prevent Clostridioides Difficile Infection in Acute Care Facilities Framework comprises 39 distinct interventions classified into five core areas: isolation and contact precautions, CDI confirmation, environmental cleaning, infrastructure development, and antimicrobial stewardship engagement.
The primary objective of the Framework was to officialise evidence-based HO-CDI prevention strategies in acute care hospitals. In current health care settings, these institutions witness an estimated 8.3 cases per 10,000 patient-days. HO-CDI involves severe diarrhea and inflammation of the colon, impacting health care costs, morbidity, mortality, and was accountable for over $1 billion in health care expenses and nearly 13,000 fatalities in the U.S. in 2017 alone.
To scrutinize the efficacy of the Framework, researchers invited hospitals within the Duke Infection Control Outreach Network to partake in an implementation study if their HO-CDI incidence rate surpassed the network’s median prior to the study. Infection preventionists from each willing hospital endorsed implementation by attending an in-person launch event and regular monthly teleconference discussions. The implementation phase spanned from July 2019 through March 2022.
The research team then contrasted HO-CDI incidence at the 20 hospitals that executed the Framework with the incidence at 26 control hospitals within the network. Sequentially, they analyzed trends within the 20 participating hospitals before and after Framework enactment. The preliminary study showcased a reduced HO-CDI incidence rate at intervention hospitals compared with control hospitals.
However, the analysis indicated an insignificant decline over time. Although the intervention hospitals experienced a significant reduction in HO-CDI incidence prior to implementing the Framework, no significant changes were observed upon the study’s inception. Upon further examination, the researchers observed a substantial drop in Framework implementation rates after the onset of the COVID-19 pandemic, likely impacting the effectiveness of the intervention.
Nonetheless, the degree to which hospitals implemented the Framework correlated with steeper declines in HO-CDI incidence, revealing potential for greater intervention effectiveness had the pandemic not disrupted implementation. The authors proposed that a scoring system based on the Framework might bridge the current gap between HO-CDI prevention recommendations and real-world application.