Outbreak: Epidemiological Surveillance, Infection Prevention and Control

Introduction: Clostridium difficile infection (CDI) is currently considered the most common cause of health care-associated infections. The aim is to describe the trend of CDI in an Italian hospital and to assess the efficacy of the measures adopted to manage the burden.

Methods: Data were retrieved in the San Salvatore Hospital of L'Aquila, from 1 January 2016 to 31 December 2018. Incidence rate of CDIs was calculated as the number of new infected persons per 10,000 patient-days. Changes in the CDI rate during the period considered were analysed using a Joinpoint regression model and related to the preventive strategies adopted. The strategies adopted focused mainly on patient isolation, reinforcement of proper hand hygiene techniques, antimicrobial stewardship and environmental disinfection.

Results: CDI/10,000 patient-days was 6.27 in 2016 and increased to 7.71 in 2017, then drastically decreased to 2.76 during 2018. The Joinpoint regression analysis identified three Joinpoints: Sep-2016, Jan-2017, and Sep-2017. There was a reduction from 2016/01 to 2016/09 (slope = -1.44; p = 0.67), then there was an increase from September 2016 to February 2017 (slope = 30.01; p = 0.29), both statistically not significant. Therefore, there was an important decrement from February 2017 to September 2017, statistically significant (slope = -15.84; p = 0.012).

Conclusions: Reports based on routine laboratory data can accurately measure population burden of CDI with limited surveillance resources. The adoption of multi-pronged strategies has proven effective in reducing CDI. It's important to keep attention high regarding preventive measures of CDI, also a continuous joint effort by all health professionals, caregivers and patients is needed.