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Effectiveness of Screening Hospital Admissions to Detect Asymptomatic Carriers of Clostridium difficile: A Modeling Evaluation

Published online by Cambridge University Press:  10 May 2016

Cristina Lanzas  and
Erik R. Dubberke
Cristina Lanzas*
Affiliation:
Department of Biomedical and Diagnostic Sciences, University of Tennessee, Knoxville, Tennessee
Erik R. Dubberke
Affiliation:
Department of Medicine, Washington University School of Medicine, St. Louis, Missouri
*
Department of Biomedical and Diagnostic Sciences, University of Tennessee, 2407 River Drive, Room A205, Knoxville, TN 37996-4543 (clanzas@utk.edu).
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Extract

Objective

Both asymptomatic and symptomatic Clostridium difficile carriers contribute to new colonizations and infections within a hospital, but current control strategies focus only on preventing transmission from symptomatic carriers. Our objective was to evaluate the potential effectiveness of methods targeting asymptomatic carriers to control C. difficile colonization and infection (CDI) rates in a hospital ward: screening patients at admission to detect asymptomatic C. difficile carriers and placing positive patients into contact precautions.

Methods

We developed an agent-based transmission model for C. difficile that incorporates screening and contact precautions for asymptomatic carriers in a hospital ward. We simulated scenarios that vary according to screening test characteristics, colonization prevalence, and type of strain present at admission.

Results

In our baseline scenario, on average, 42% of CDI cases were community-onset cases. Within the hospital-onset (HO) cases, approximately half were patients admitted as asymptomatic carriers who became symptomatic in the ward. On average, testing for asymptomatic carriers reduced the number of new colonizations and HO-CDI cases by 40%–50% and 10%–25%, respectively, compared with the baseline scenario. Test sensitivity, turnaround time, colonization prevalence at admission, and strain type had significant effects on testing efficacy.

Conclusions

Testing for asymptomatic carriers at admission may reduce both the number of new colonizations and HO-CDI cases. Additional reductions could be achieved by preventing disease in patients who are admitted as asymptomatic carriers and developed CDI during the hospital stay.

Information

Type
Original Article
Information
Infection Control & Hospital Epidemiology , Volume 35 , Issue 8 , August 2014 , pp. 1043 - 1050
Copyright
© 2014 by The Society for Healthcare Epidemiology of America. All rights reserved.

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