{"id":25805,"date":"2024-05-29T04:54:00","date_gmt":"2024-05-28T20:54:00","guid":{"rendered":"http:\/\/csccm.org.cn\/?p=25805"},"modified":"2024-05-29T05:55:09","modified_gmt":"2024-05-28T21:55:09","slug":"jama-intern-med%e5%8f%91%e8%a1%a8%e8%ae%ba%e6%96%87-%e5%9c%a8%e5%9c%b0%e5%8c%ba%e5%8c%bb%e9%99%a2%e7%bd%91%e7%bb%9c%e5%ae%9e%e6%96%bdcdc%e5%8c%bb%e9%99%a2%e5%8f%91%e7%94%9f%e7%9a%84%e9%9a%be","status":"publish","type":"post","link":"https:\/\/csccm.org.cn\/?p=25805","title":{"rendered":"[JAMA Netw Open\u53d1\u8868\u8bba\u6587]: \u5728\u5730\u533a\u533b\u9662\u7f51\u7edc\u5b9e\u65bdCDC\u533b\u9662\u53d1\u751f\u7684\u96be\u8fa8\u68ad\u72b6\u82bd\u5b62\u6746\u83cc\u611f\u67d3\u9884\u9632\u63aa\u65bd"},"content":{"rendered":"\n

Original Investigation <\/p>\n\n\n\n

Infectious Diseases<\/p>\n\n\n\n

March 27, 2024<\/p>\n\n\n\n

CDC\u2019s Hospital-Onset Clostridioides difficile<\/em> Prevention Framework in a Regional Hospital Network<\/h1>\n\n\n\n

Nicholas A.\u00a0Turner,\u00a0Jay\u00a0Krishnan,\u00a0Alicia\u00a0Nelson,\u00a0et al<\/h3>\n\n\n\n

JAMA Netw Open.\u00a0<\/em>2024;7(3):e243846. doi:10.1001\/jamanetworkopen.2024.3846<\/h3>\n\n\n\n

<\/a>Key Points<\/p>\n\n\n\n

Question<\/strong>  Was implementation of the Centers for Disease Control and Prevention\u2019s Strategies to Prevent Clostridioides difficile<\/em> Infection in Acute Care Facilities Framework (hereafter, the Framework) in a regional hospital network associated with a decrease in hospital-onset C difficile<\/em> infections (HO-CDI)?<\/p>\n\n\n\n

Findings<\/strong>  In this quality improvement study of 2184 HO-CDI cases (7\u202f269\u202f429 patient-days), the 20 hospitals participating in the Framework had a steeper decline in HO-CDI incidence vs 26 nonparticipating hospitals, but implementation of the Framework was not temporally associated with the decline. The incidence of HO-CDI was declining in participating hospitals before the intervention, and the rate of decline did not change during the intervention.<\/p>\n\n\n\n

Meaning<\/strong>  Findings of this study suggest that benefits from implementation of the Framework warrant further study.<\/a><\/p>\n\n\n\n

Abstract<\/p>\n\n\n\n

Importance<\/strong>  Despite modest reductions in the incidence of hospital-onset Clostridioides difficile<\/em> infection (HO-CDI), CDI remains a leading cause of health care\u2013associated infection. As no single intervention has proven highly effective on its own, a multifaceted approach to controlling HO-CDI is needed.<\/p>\n\n\n\n

Objective<\/strong>  To assess the effectiveness of the Centers for Disease Control and Prevention\u2019s Strategies to Prevent Clostridioides difficile<\/em> Infection in Acute Care Facilities Framework (hereafter, the Framework) in reducing HO-CDI incidence.<\/p>\n\n\n\n

Design, Setting, and Participants<\/strong>  This quality improvement study was performed within the Duke Infection Control Outreach Network from July 1, 2019, through March 31, 2022. In all, 20 hospitals in the network participated in an implementation study of the Framework recommendations, and 26 hospitals did not participate and served as controls. The Framework has 39 discrete intervention categories organized into 5 focal areas for CDI prevention: (1) isolation and contact precautions, (2) CDI confirmation, (3) environmental cleaning, (4) infrastructure development, and (5) antimicrobial stewardship engagement.<\/p>\n\n\n\n

Exposures<\/strong>  Monthly teleconferences supporting Framework implementation for the participating hospitals.<\/p>\n\n\n\n

Main Outcomes and Measures<\/strong>  Primary outcomes were HO-CDI incidence trends at participating hospitals compared with controls and postintervention HO-CDI incidence at intervention sites compared with rates during the 24 months before the intervention.<\/p>\n\n\n\n

Results<\/strong>\u00a0\u00a0The study sample included a total of 2184 HO-CDI cases and 7\u202f269\u202f429 patient-days. In the intervention cohort of 20 participating hospitals, there were 1403 HO-CDI cases and 3\u202f513\u202f755 patient-days, with a median (IQR) HO-CDI incidence of 2.8 (2.0-4.3) cases per 10\u202f000 patient-days. The first analysis included an additional 3\u202f755\u202f674 patient-days and 781 HO-CDI cases among the 26 controls, with a median (IQR) HO-CDI incidence of 1.1 (0.7-2.7) case per 10\u202f000 patient-days. The second analysis included an additional 2\u202f538\u202f874 patient-days and 1751 HO-CDI cases, with a median (IQR) HO-CDI incidence of 5.9 (2.7-8.9) cases per 10 000 patient-days, from participating hospitals 24 months before the intervention. In the first analysis, intervention sites had a steeper decline in HO-CDI incidence over time relative to controls (yearly incidence rate ratio [IRR], 0.79 [95% CI, 0.67-0.94];\u00a0P<\/em>\u2009=\u2009.01), but the decline was not temporally associated with study participation. In the second analysis, HO-CDI incidence was declining in participating hospitals before the intervention, and the rate of decline did not change during the intervention. The degree to which hospitals implemented the Framework was associated with steeper declines in HO-CDI incidence (yearly IRR, 0.95 [95% CI, 0.90-0.99];\u00a0P<\/em>\u2009=\u2009.03).<\/p>\n\n\n\n

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Conclusions and Relevance<\/strong>  In this quality improvement study of a regional hospital network, implementation of the Framework was not temporally associated with declining HO-CDI incidence. Further study of the effectiveness of multimodal prevention measures for controlling HO-CDI is warranted.<\/p>\n","protected":false},"excerpt":{"rendered":"

Original Investigation  Infectious Diseases March& […]<\/p>\n","protected":false},"author":3,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[32,23],"tags":[],"_links":{"self":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25805"}],"collection":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcomments&post=25805"}],"version-history":[{"count":2,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25805\/revisions"}],"predecessor-version":[{"id":25807,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=\/wp\/v2\/posts\/25805\/revisions\/25807"}],"wp:attachment":[{"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fmedia&parent=25805"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Fcategories&post=25805"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/csccm.org.cn\/index.php?rest_route=%2Fwp%2Fv2%2Ftags&post=25805"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}