Post on 11-Nov-2018
Clostridium difficileQuali novità emergono dalle recenti linee guida rispetto al documento di
indirizzo SIMPIOS 2011 in termini di prevenzione, diagnosi e terapia delle Infezioni da Clostridium difficile?
Dr. Andrea Patroni
VIII Congresso Nazionale
Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie
21-23 Maggio 2018
Bergamo, Ospedale Papa Giovanni XXIII
EPIDEMIOLOGY
II. What is the minimal surveillance
recommendation for institutions with
limited resources?
EPIDEMIOLOGY
IV. How should CDI surveillance be
approached in settings of high endemic
rates or outbreaks?
II. Surveillance
Does surveillance of CDI in combination with
appropriate feedback of infection rates lead to
reduced CDI rates?
DIAGNOSIS
VI. What is the preferred population for C.
difficile testing, and should efforts be
made to achieve this target?
DIAGNOSIS
VII. What is the best-performing method for
detecting patients at increased risk for
clinically significant C. difficile infection
in community submitted stool
specimens?
I. Diagnostic approach for prevention of
transmission
DIAGNOSIS
VIII. What is the most sensitive method of
diagnosis of CDI in stool specimens
from patients likely to have CDI based
on clinical simptoms?
I. Diagnostic approach for prevention of
transmission
DIAGNOSIS
IX. What is the role of repeat testing, if
any? Are there asymptomatic patients
in whom repeat testing should be
allowed, including test of cure?
DIAGNOSIS
X. Does detection of fecal lactoferrin or
another biologic marker improve the
diagnosis of CDI over and above the
detection of toxigenic C. difficile Can
such a subset predict a more ill cohort?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XIII. Should private rooms and/or dedicated
toilet facilities be used for isolated
patients with CDI?
VIII. Infrastructure
Are infrastructural changes effective in reducing
transmission of C. difficile in hospitals?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XIV. Should gloves and gowns be worn while
caring for isolated CDI patients?
V. Personal protective equipment (PPE)
How effective is the additional use of personal
protective equipment (PPE) in reducing C.
difficile infection/transmission, compared to
standard precautions only?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XV. When should isolation be implemented?
VI. Contact precautions
Are contact precautions for CDI patients effective
in reducing the CDI rate/transmission of C.
difficile in hospital settings?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XVI. How long should isolation be continued?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XVII. What is the recommended hand hygiene
method (assuming glove use) when
caring for patients in isolation for CDI?
IV. Hand hygiene
Which are the most effective techniques/products for removal of C. difficile or its spores from hands?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XVII. What is the recommended hand hygiene
method (assuming glove use) when
caring for patients in isolation for CDI?
IV. Hand hygiene
Is ethanol-based habd rub associated with increased CDI rates compared with hand washing?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XVIII.Should patient bathing interventions be
implemented to prevent CDI?
IV. Hand hygiene
Is hand hygiene compliance associated with CDI
transmission?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XIX. Should noncritical devices or equipment
be dedicated to or specially cleaned after
being used on the isolated patient with
CDI?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XX. What is the role of manual, terminal
disinfection using a C. difficile
sporacidal agent for patients in isolation
for CDI?
VII. Environmental cleaning and disinfection
Does environmental disinfection of rooms of
patients with CDI decrease the transmission of
C. difficile compared with routine cleaning?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXI. Should cleaning adequacy be evaluated?
VII. Environmental cleaning and disinfection
Are no-touch disinfection systems as effective as
hypochlorite to reduce the environmental
contamination in rooms of patients with CDI?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXII. What is the role of automated terminal
disinfection using a method that is
sporicidal against C. difficile?
VII. Environmental cleaning and disinfection
Are no-touch disinfection systems effective in reducing transmission/incidence of C. difficile?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXIII. What is the role of daily sporicidal
disinfection?
VII. Environmental cleaning and disinfection
Does environmental disinfection of rooms of
patients with CDI decrease the transmission of
C. difficile compared with routine cleaning?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXIV. Should asymptomatic carriers of C.
difficile be identified and isolated if
positive?
III. Screening of asymptomatic patients and
healthcare workers for C. difficile
carriage
Does screening for C. difficile identify colonised/carrier patients at increased or decreased risk of developing C. difficile infection?
III. Screening of asymptomatic patients and
healthcare workers for C. difficile
carriage
Are healthcare workers with contact to C. difficile-positive patients at risk for asymptomatic colonization or infection with C. difficile and should screening of healthcare workers for carriage of C. difficile to reduce CDI rates be reccommended?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXV. What is the role of antibiotic
stewardship in controlling CDI rates?
IX. Antibiotic stewardship
Is restriction of antibiotic agents/classes effective in reducing CDI rate in hospitals?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXV. What is the role of antibiotic
stewardship in controlling CDI rates?
IX. Antibiotic stewardship
Is reducing length of antibiotic therapy effective in reducing CDI rates in hospitals?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXVI. What is the role of proton pump
inhibitor restriction in controlling CDI
rates?
PREVENTION AND CONTROL
Isolation Measures for Patients With CDI
XXVII. What is the role of probiotics in primary
prevention of CDI?
TREATMENT
XXVIII. What are important ancillary treatment
strategies for CDI?
X. Early treatment (focus on prevention of
transmission)
Can early treatment of suspected/diagnosed patients with CDI reduce the transmission of C. difficile?
TREATMENT
XXIX. What are the best treatment of an
iniatial CDI episode to ensure resolution
of symptoms and sustained resolution 1
month after treatment?
XXX. What ate the best treatments of
fulminant CDI?
XXXI. What are the best treatments for
recurrent CDI?
TREATMENT (Pediatric considerations)
XXXII. What is the best treatment of an initial
episode or fist recurrence of nonsevere
CDI in children?
XXXIII. What is the best treatment of an initial
episode of severe CDI in children?
XXXIV. What is the best treatments for a
second or greater episode of recurrent
CDI in children?
XXXV. Is there a role for fecal microbiota
transplantation in children with recurrent
CDI?
XI. Education
How does implementation of intensified teaching,
e-learning, direct observation, testing influence C.
difficile transmission/prevalence in hospitals?
XI. Education
Does specific education enhance thoroughness of cleaning in the context of CDI prevention?