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Screening for Asymptomatic Clostridium difficile Among Bone Marrow Transplant Patients: A Mixed-Methods Study of Intervention Effectiveness and Feasibility

Published online by Cambridge University Press:  25 January 2018

Anna K. Barker ,
Benjamin Krasity ,
Jackson Musuuza  and
Nasia Safdar
Anna K. Barker
Affiliation:
Department of Population Health Sciences, University of Wisconsin–Madison, Madison, Wisconsin
Benjamin Krasity
Affiliation:
School of Medicine and Public Health, University of Wisconsin–Madison, Madison, Wisconsin
Jackson Musuuza
Affiliation:
William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin
Nasia Safdar*
Affiliation:
William S. Middleton Memorial Veterans Affairs Hospital, Madison, Wisconsin Department of Medicine, Division of Infectious Disease, University of Wisconsin–Madison, Madison, Wisconsin
*
Address correspondence to Nasia Safdar, Department of Medicine, Division of Infectious Disease, University of Wisconsin–Madison, 1685 Highland Avenue, Madison, Wisconsin ([email protected]).
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Abstract

OBJECTIVE

To identify facilitators and barriers to implementation of a Clostridium difficile screening intervention among bone marrow transplant (BMT) patients and to evaluate the clinical effectiveness of the intervention on the rate of hospital-onset C. difficile infection (HO-CDI).

DESIGN

Before-and-after trial

SETTING

A 505-bed tertiary-care medical center

PARTICIPANTS

All 5,357 patients admitted to the BMT and general medicine wards from January 2014 to February 2017 were included in the study. Interview participants included 3 physicians, 4 nurses, and 4 administrators.

INTERVENTION

All BMT patients were screened within 48 hours of admission. Colonized patients, as defined by a C. difficile–positive polymerase chain reaction (PCR) stool result, were placed under contact precautions for the duration of their hospital stay.

METHODS

Interview responses were coded according to the Systems Engineering Initiative for Patient Safety conceptual framework. We compared pre- and postintervention HO-CDI rates on BMT and general internal medicine units using time-series analysis.

RESULTS

Stakeholder engagement, at both the person and organizational level, facilitates standardization and optimization of intervention protocols. While the screening intervention was generally well received, tools and technology were sources of concern. The mean incidence of HO-CDI decreased on the BMT service postintervention (P<.0001). However, the effect of the change in the trend postintervention was not significantly different on BMT compared to the control wards (P=.93).

CONCLUSIONS

We report the first mixed-methods study to evaluate a C. difficile screening intervention among the BMT population. The positive nature by which the intervention was received by front-line clinical staff, laboratory staff, and administrators is promising for future implementation studies.

Infect Control Hosp Epidemiol 2018;39:177–185

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 39 , Issue 2 , February 2018 , pp. 177 - 185
Copyright
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved 

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