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

2011

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2018

EPIDEMIOLOGY

I. How are CDI cases best defined?

EPIDEMIOLOGY

II. What is the minimal surveillance

recommendation for institutions with

limited resources?

EPIDEMIOLOGY

III. What is the best way to express CDI

incidence and rates?

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?

EPIDEMIOLOGY

V. What is the recommended CDI

surveillance strategy for pediatric

institutions?

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?

DIAGNOSIS

XI. When should a neonate or infant be

tested for C. difficile?

DIAGNOSIS

XII. When should a toddler or older child be

tested for C. difficile?

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

Is specific education required to enhance

knowledge regarding prevention od 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?

XI. Education

Should CDI patients and visitors be educated on

prevention measures for CDI?

Quindi …

Grazie!

VIII Congresso Nazionale

Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie

21-23 Maggio 2018

Bergamo, Ospedale Papa Giovanni XXIII