Clostridioides difficile Controlled at Hospital During COVID-19 Surge

One of the bigger challenges during COVID-19 surges for IPs involved keeping tabs on the host of other deadly pathogens that cause health care–acquired infections (HAIs). However, just as the mitigation measures used to fight COVID-19 in the public—hand hygiene, social distancing, wearing a mask—reduced the incidence of influenza in the 2020-2021 flu season to historic lows,¹ the measures used to combat COVID-19 in hospitals may have helped reduce incidents of HAIs. Better hand hygiene compliance may have been especially important, according to a study unveiled last month at the APIC annual conference.

According to investigators with Mount Sinai Morningside in New York, the rates of Clostridioides difficile infection (CDI) laboratory-identified events remained about the same in March, April, and May of 2020 as they were during the same 3 months in 2019. Investigators compared the C. diff rates per 10,000 patient days for both periods, as well as the number of C. diff tests ordered.

“Additionally, the doctor of pharmacy from our antibiotic stewardship team reviewed all orders for oral vancomycin to determine if empiric CDI treatment was initiated without confirmatory testing,” the study authors state.

Among those authors is Barbara Smith, RN, BSN, MPA, CIC, an infection preventionist at Mount Sinai Morningside. She tells ICT® that there was 1 case in 2020 in which the patient who’d been given oral vancomycin did in fact have C. diff. “So that was valid,” Smith tells ICT®. “There was another woman who had come in with C. diff She was valid to receive that treatment.” Smith said she decided to study incidents of C. diff when hospital providers noticed an increase in the number of central line–associated bloodstream infections, although she realized that the increase “was understandable given the crisis situation [with COVID-19] and the condition of the patients.

“You would think that with the amount of antibiotics these COVID-19 patients received that that [the C. diff rate] would have gone through the roof, but it didn’t,” Smith added.

Investigators found a minuscule increase in C. diff during the 3 months in 2020: 0.48 per 10,000 patient days compared with 0.00 in 2019. In addition, the number of tests rose in 2020 to 17.5 per 10,000 patient days from 15.8 during the 2019 months. In 2020, 3 patients received oral vancomycin.

“We speculate that the lack of an increase in CDI rates may be attributed to increased hand hygiene by staff—compliance increased to 91% in 2020 compared with 83% in 2019—enhanced attention to cleaning and high-level disinfection, and improved adherence to use of personal protective equipment,” the authors concluded.

Smith tells ICT® that she wanted to make sure there were no mitigating factors, such as a decrease in testing for C. diff. “Were people not testing the same amount? Maybe the doctors were just starting treatment without testing. But that, too, was not found to be statistically significant,” notes Smith. “The volume of patients tested in 2019 was the same, or similar, as the volume in 2020. We didn’t feel like people were just missing the cases. The [patients] who were diagnosed and who did need treatment were getting it.”

Smith says that patients with C. diff are put in isolation; they cannot leave their hospital room for anything other than a medical test. “People who are entering the room [of a patient with C. diff] can use a sanitizer to go in. They do wear full gloves and gowns, which they should be removing before they leave the room. And [they should be] using soap and water when they exit the room,” points out Smith, “because, as you know, the alcohol sanitizers don’t kill the spores. Actually, neither does the soap and water. It just flushes it down the drain.”

Reference:

1. Diamond F. CDC’s flu czar says she’s ready for the fall offensive. Infection Control Today®. June 4, 2021. Accessed June 15, 2021. https://www.infectioncontroltoday.com/view/cdc-s-flu-czar-says-she-s-ready-for-the-fall-offensive