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Clostridium difficile infection spread within the hospital environment

Rangachar Srinivasa, Vatsala (2018) Clostridium difficile infection spread within the hospital environment. Master's Thesis, University of Pittsburgh. (Unpublished)

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Background: Clostridium difficile Infection (CDI) is one of the leading causes of hospital-associated infections (HAIs) and accounts for nearly half a million infections in the United States (2015). It was associated with approximately 29,000 deaths nationwide in 2011. This study focusses on the role of the environment in the spread of CDI within a hospital in a non-outbreak setting.

Statement of public health significance: The Centers for Disease Control and Prevention (CDC) classifies CDI threat rate as five, which requires urgent and aggressive public health action, because CDI is associated with significant morbidity and mortality. Also, the hospitalization costs associated with CDI increase by over 50%.

Method: This study was conducted at a 495- bed academic University-affiliated single center. The first step includes the performance of bed tracing on all positive CDI admitted patients in the year 2016. The second step included the collection of environmental cultures of the immediate patient surrounding shared devices and floors to identify lapses in environmental cleaning. Aerobic environmental cultures were performed for CDI followed by Gram stain and anaerobic confirmatory culture. Both biochemical and molecular testing was used to confirm Clostridium difficile (CD) presence.

Results: Bed tracing was performed for 115 hospital-associated (HA)- and 96 community-associated (CA)- CDI patients. Initial analysis between HA-CDI and CA-CDI revealed that the length of stay was significantly longer in HA-CDIs. However, readmission and recurrence were significantly higher in CA-CDIs. Bed-tracing showed a limited list of high burden rooms. Environmental Cultures revealed only 2 out of 81 surfaces, 14 out of 28 floors & 3 out of 20 wheelchairs as positive for CD spores. None of these patients’ rooms had active CDI patients.

Conclusion: Bed tracing and environmental culturing are important public health tools for recognizing rooms with high density of CDI and are particularly important in outbreak settings or any increase in incidence. Shared devices (such as wheel chairs) and floors of patients’ rooms could serve as a reservoir for CD spores. Routine monitoring of disinfection adequacy of shared devices and floors is an important step to assure a safe patient environment.


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Item Type: University of Pittsburgh ETD
Status: Unpublished
CreatorsEmailPitt UsernameORCID
Rangachar Srinivasa, Vatsalavar35@pitt.eduvar35
ETD Committee:
TitleMemberEmail AddressPitt UsernameORCID
Thesis Advisorkingsley,
Committee MemberYassin,
Committee MemberFrank,
Date: 28 June 2018
Date Type: Publication
Defense Date: 9 April 2018
Approval Date: 28 June 2018
Submission Date: 5 April 2018
Access Restriction: 3 year -- Restrict access to University of Pittsburgh for a period of 3 years.
Number of Pages: 53
Institution: University of Pittsburgh
Schools and Programs: School of Public Health > Infectious Diseases and Microbiology
Degree: MPH - Master of Public Health
Thesis Type: Master's Thesis
Refereed: Yes
Uncontrolled Keywords: Environmental culturing, bed tracing, Clostridium difficile, Hospital associated infections, Microbiology
Date Deposited: 28 Jun 2018 19:46
Last Modified: 01 May 2021 05:15


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