Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland.

Background and Objectives: Gastrointestinal tract infections caused by Clostridioides difficile bacteria are diagnosed in pediatric patients with increasing frequency. Children treated at pediatric units are a group of patients at high risk of this infection; therefore, appropriate differential diagnostics and an individual approach to every case are of particular importance. The goal of the study was to assess the clinical parameters of patients with a confirmed CD infection and colonization. Materials and Methods: Every positive case was subjected to a retrospective analysis based on medical history and an infection notification note. Results: Positive results were obtained for 30 patients, among whom the results of 18 patients were considered to justify the diagnosis of an infection. In the remaining patients, treatment was not initiated in only three cases. Cases were detected where treatment was initiated despite the lack of sufficient clinical evidence. Conclusions: This study demonstrates that there are many factors that result in a high risk of the occurrence of CDI in oncology patients, such as antibiotic therapy, multiple hospitalizations, and myelosuppression.

Detection and Analysis of Clostridioides difficile Spores in a Hospital Environment.

Clostridioides difficile, due to its long survival time in a hospital environment, is considered to be one of the most frequent factors in healthcare-associated infections. Patient care requires not only rapid and accurate diagnosis, but also knowledge of individual risk factors for infections, e.g., with C. difficile, in various clinical conditions. The goal of this study was to analyse the degree of contamination of a hospital environment with C. difficile spores. Culturing was performed using C diff Banana BrothTM medium, which enables germination of the spores of these bacteria. Samples were collected from inanimate objects within a hospital environment in a specialist hospital in Poland. The results of the study demonstrated the presence of 18 positive samples of Clostridioides spp. (15.4%). Of these, C. difficile spores were detected in six samples, Clostridioides perfringens in eight samples, Clostridioides sporogenes in two samples and Clostridioides innocuum and Clostridioides baratii in one sample each. Among the six samples of C. difficile, a total of four strains which produce the B toxin were cultured. The binary toxin related to ribotype 027 was not detected in our study. Nosocomial infection risk management is a significant problem, mainly concerning the issues of hygiene maintenance, cleaning policy and quality control, and awareness of infection risk.

Hand hygiene as the basic method of reducing Clostridium difficile infections (CDI) in a hospital environment.

INTRODUCTION: Clostridium difficile spores, due to their ability to adapt to adverse conditions in a hospital environment, cause enormous difficulties associated with the effective decontamination of surfaces and equipment. Elimination of this pathogen is possible through effective implementation of the hand hygiene procedure by all hospital employees. Scientific research indicates that a properly adopted hand washing procedure reduces the risk of Clostridium difficile infection (CDI) by half. OBJECTIVE: The aim of the study was to indicate the sources of nosocomial infections, mainly Clostridium difficile infection, and methods to limit them, with particular attention paid to the proper hand hygiene of the medical staff, which plays a fundamental role in the transmission of infections between hospitalized patients. BRIEF DESCRIPTION OF THE STATE OF KNOWLEDGE: Epidemiological studies indicate that about a half of Healthcare Associated Infection (HAI) is caused by microbes that contaminate the hands of medical personnel. One of the main pathogens is Clostridium difficile, which in 2018 in Poland accounted for 41.52% of all detected outbreaks originating from the hospital environment. According to data from WHO,16 million people worldwide die from Healthcare Associated Infection every year, of which approximately 17% constitutes mortality among people infected with Clostridium difficile. CONCLUSIONS: Non-compliance with hand hygiene among members of medical staff contributes to nosocomial infections which are a major cause of disease complications and deaths. Proper hand hygiene is a key measure for reducing this phenomenon. In every medical institution, especially in hospitals, and staff should be reminded about it and trained to perform the correct hand hygiene technique.

Nosocomial infections as one of the most important problems of healthcare system.

Healthcare-associated infections (HAI) are commonly defined as adverse events resulting from the provision of healthcare. The reduction of risk arising from the spread of pathogenic microorganisms in the hospital environment is a considerable challenge in the context of the proper functioning of the medical services sector. The financial costs of hospitals resulting from HAI are a serious problem for the Polish healthcare system. The spread of strains with a high level of drug resistance in individual hospitals is associated with the local epidemiological situation. In 2015-2017, there was a high increase in the number of infections caused by New Delhi strains. The highest increase due to this strain occurred in Mazowieckie and Podlasie provinces. The dynamics of infection caused by New Delhi strains throughout Poland in 2015-2016 indicated an increase of 278.7%. In 2017, the phenomenon of antibiotic abuse in all regions of Poland was 24% higher than the EU average. One of the reasons is the insufficient number of diagnostic tests ordered by both general practitioners and doctors representing hospital care. In 2016-2017, the average number of microbiological tests in diagnosing hospital infections performed annually within the entire territory of Poland was 50% lower than in European Union countries and the number recommended by WHO. Increased, and at the same time inappropriate antibiotic therapy led to a build-upof drug resistance among bacterial species of significant clinical importance. The current epidemiological situation imposes the necessity for constant HAI control and broadly understood rationalization of the guidelines of hospital antibiotic policy.

Level of Knowledge of Medical Staff on the Basis of the Survey in Terms of Risk Management, Associated with Clostridioides difficile Infections.

Infections caused by the toxigenic strains of Clostridioides difficile in the hospital environment pose a serious public health problem. The progressive increase in hospital infections in Poland indicates that risk management is a tool that is not used in an effective way and significantly differs from the goals set by the Leading Authorities, the Ministry of Health and its subordinate units. Systematic education of medical personnel constitutes the basic element of rational risk management aimed at reducing the number of infections as it allows for the transfer of knowledge, development of appropriate organizational procedures, and improves internal communication. This paper presents the results of a survey conducted in hospital facilities throughout Poland. The study dealt with what medical personnel know about channels of transmission and prevention of Clostridioides difficile infections in the hospital setting, professional training and risk management in terms of reducing the number of infections. The survey reveals that Clostridioides difficile continues to be a serious problem in the inpatient care system. Procedures and management strategies implemented by hospitals in order to limit the spread of the pathogen are predominantly focused on short-term action, which does not lead to a real improvement in terms of hospitalized patients' safety. The infection risk management system was assessed at a fairly low level. The obtained research results confirmed the research hypotheses that had been formulated.

Costs Associated with the Treatment of Clostridioides Difficile Infections.

BACKGROUND: Clostridioides difficile, as the main cause of infectious diarrhoea in hospitalised patients, is a considerable challenge for medical personnel (hospital environment) who have direct contact with the patient, as well as being of interest to public health specialists. Financial issues related to the occurrence of the above-mentioned micro-organism are being increasingly raised. Due to the scale of the phenomenon, we are beginning to pay attention to the significant system costs caused by the diagnosis and treatment of CDI infection and its complications. Studies indicate that the nosocomial infection of C. difficile complicates hospitalisation, by increasing the cost by more than half and extending patient's stay by an average of 3.6 days. MATERIAL AND METHODS: The aim of this study was to attempt to calculate the estimated costs associated with the prolonged hospitalisation of patients with nosocomial CDI infection, using the example of a hospital in Lodz. A total of 53 completed hospitalisations of patients treated in the period of January-August 2018 were analysed, during which hospital Clostridioides difficile infection was identified. For the purposes of this study, statistical data collected in the hospital's IT system were also analysed, covering 44,868 hospitalisations in the Jan-Aug 2018 period, during which no hospital infection occurred. They was a control group, in which the analysed cases were compared. The obtained data in the study determined how long each patient with Clostridioides difficile infection stayed in the hospital (from the moment infection was diagnosed until the day of hospital discharge), and which diagnosis related groups (DRG) (according to National Health Fund guidelines) were assigned. The average length of patient stay without infection within a given DRG group in each hospital ward was also determined. The collected materials became the initial point for the final analysis of hospital costs and the length of hospital stay caused by Clostridioides difficile infection. RESULTS: Clostridioides difficile infection extended the hospital stay by an average of almost 12 days. The average cost of prolonged hospitalisation due to CDI infection (according to the average cost per person-day) was about PLN 7148 (1664 EUR), which gave a total value of about PLN 378,860.6 (88,240.5 EUR) in the examined period. At the same time, the average expenditure from the National Health Fund for hospitalisation due to CDI infections increased by about PLN 6627 (1542.8 EUR), which in the analysed period translated into over PLN 351,232.0 (81,505.5 EUR) (according to settlements with the National Health Fund). The outcome indicates that there is a clear relation between CDI and the anticipated length of hospitalisation of patients without an infection.

Problems of Clostridium difficile infection (CDI) in Polish healthcare units.

The issue of patient safety during the provision of health services poses a key challenge in health policy. The number of hospital-acquired infections (also known as HAI - Healthcare Associated Infection) determines the level of quality of health services provided in a given health facility. Effective management reinforced by the awareness of a team of medical professionals allows not only reduction in the hospital's finances, but also the frequency of adverse events, which undoubtedly include hospital-acquired infections. Good cooperation between departments and a Hospital Infection Control Committee is one of the key aspects that translates to the rapid identification of new epidemic outbreaks. Infections caused by strains of Clostridium difficile (CDI, Clostridium difficile infection) are one of the main factors responsible for the prolonged hospitalization of patients. In the United States, Clostridium difficile causes almost half a million infections annually, and its treatment costs are estimated at nearly $ 4.8 billion per year. In Poland, the number of CDI cases in 2018 was 11.592 (for comparison, in 2013 the number of infections caused by this bacterium was 4.728). Hospital environment, inappropriate antibiotic therapy and development of multi-drug resistant strains increase the risk of infections. In order to improve the safety of hospitalized patients, infection risk management should be a systemic, formalized activity integrated with the overall process of managing a health facility. It is necessary that central units have interest in creating effective tools to enable successful epidemiological supervision and the implementation of strategic assumptions of health policy in this area.

Application of a Novel PM Model to Assess the Risk of Clostridioides difficile Infections in Medical Facilities as a Tool for Improving the Quality of Health Services and the Safety of Patients.

Infections with multi-drug resistant microorganisms associated with the provision of health services have become an acute problem worldwide. These infections cause increased morbidity as well as mortality and are a financial burden for the healthcare system. Effective risk management can reduce the spread of infections and thus minimize their number in hospitalized patients. We have developed a new approach to the analysis of hazards and of exposure to the risk of adverse events by linking the patient's health record system to the entire infrastructure of the hospital unit. In this study, using the developed model, we focused on infections caused by the Clostridioides difficile bacterium, as they constitute a significant number of nosocomial infections in Poland and worldwide. The study was conducted in a medical facility located in the central part of Poland which provides tertiary care. In the proposed PM model, a risk analysis of hospital acquired infections at the Intensive Care and Anesthesiology Unit combined with the hospital's technical facilities and organizational factors was conducted. The obtained results indicate the most critical events which may have an impact on potential hazards or risks which may result from the patient's stay at the specific ward. Our method can be combined with an anti-problem approach, which minimizes the critical level of infection in order to determine the optimal functioning of the entire hospital unit. Research has shown that in most situations the spread dynamics of nosocomial infections can be controlled and their elimination may be attempted. In order to meet these conditions, the persons responsible for the daily operation of the medical facility and its individual wards have to indicate potential events and factors which present a risk to the hospitalized patients. On the basis of a created spreadsheet directions for improvement may be finally established for all potential events, their frequency may be minimized, and information may be obtained on actions which should be undertaken in a crisis situation caused by the occurrence of a given phenomenon. We believe that the proposed method is effective in terms of risk reduction, which is important for preventing the transmission of multi-drug resistant microorganisms in the hospital environment.