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Potential causal effect of contact precautions and isolation on Clostridioides difficile infection in the hyperendemic setting: Interrupted time-series analyses before and after implementation

Authors
 Eun Hwa Lee  ;  Hye Sun Lee  ;  Kyoung Hwa Lee  ;  Young Goo Song  ;  Sang Hoon Han 
Citation
 JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION, Vol.56(5) : 1054-1063, 2023-10 
Journal Title
JOURNAL OF MICROBIOLOGY IMMUNOLOGY AND INFECTION
ISSN
 1684-1182 
Issue Date
2023-10
MeSH
Bayes Theorem ; COVID-19* / epidemiology ; COVID-19* / prevention & control ; Clostridioides difficile* ; Clostridium Infections* / epidemiology ; Clostridium Infections* / prevention & control ; Cross Infection* / epidemiology ; Cross Infection* / prevention & control ; Humans ; Pandemics
Keywords
Clostridioides difficile ; Contact precaution ; Incidence ; Isolation ; Time-series analysis
Abstract
Background: Recent studies disputed the effectiveness of efforts to comply with contact precautions and isolation (CPI) considering relatively low intra-hospital transmission rate of healthcare facility-associated Clostridioides difficile infection (HCFA-CDI). We evaluated the potential causal effect of CPI on HCFA-CDI occurrence by comparing the incidence rate (IR) for different time periods with and without CPI implementation.

Methods: Long-term observational time-series data were separated into three periods (pre-CPI: January 2012-March 2016, CPI: April 2016-April 2021, post-CPI: May 2021-December 2022). CPI was suspended owing to the restriction of isolation rooms during the COVID-19 pandemic. We inferred potential causal outcomes by comparing predicted and observed IRs of HCFA-CDI using interrupted time-series analyses, including the Bayesian structural time-series or autoregressive integrated moving average (ARIMA) model in the R-language or SAS software.

Results: The monthly observed IR (44.9/100,000 inpatient-days) during the CPI period was significantly lower than the predicted IR (90.8) (-50.6% relative effect, P = 0.001). However, the observed IR (52.3) during the post-CPI period was significantly higher than the predicted IR (39.1) (33.6%, P = 0.001). The HCFA-CDI IR decreased during CPI (-14.3, P < 0.001) and increased post-CPI (5.4, P < 0.001) in the multivariable ARIMA model, which controlled for antibiotic usage, handwashing with soap and water, and number of toxin tests.

Conclusions: Various time-series models revealed that CPI implementation had a potential causal effect on the reduction of HCFA-CDI incidence.
Files in This Item:
T202305562.pdf Download
DOI
10.1016/j.jmii.2023.06.003
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Yonsei Biomedical Research Center (연세의생명연구원) > 1. Journal Papers
Yonsei Authors
Song, Young Goo(송영구) ORCID logo https://orcid.org/0000-0002-0733-4156
Lee, Kyoung Hwa(이경화) ORCID logo https://orcid.org/0000-0003-0033-1398
Lee, Eun Hwa(이은화)
Lee, Hye Sun(이혜선) ORCID logo https://orcid.org/0000-0001-6328-6948
Han, Sang Hoon(한상훈) ORCID logo https://orcid.org/0000-0002-4278-5198
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/196489
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