Screening for Asymptomatic Clostridium difficile Among Bone Marrow Transplant Patients: A Mixed-Methods Study of Intervention Effectiveness and Feasibility
Screening for Asymptomatic Clostridium difficile Among Bone Marrow Transplant Patients: A Mixed-Methods Study of Intervention Effectiveness and Feasibility
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DOI：
10.1017/ice.2017.286
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发表时间：
2018-02-01
影响因子：
4.5
通讯作者：
Safdar, Nasia
中科院分区：
文献类型：
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作者：
Barker, Anna K.;Krasity, Benjamin;Safdar, Nasia
客观的。旨在确定在骨髓移植 (BMT) 患者中实施艰难梭菌筛查干预措施的促进因素和障碍，并评估干预措施对医院发病艰难梭菌感染率 (HO-CDI) 的临床有效性。设计。试验设置之前和之后。拥有 505 个床位的三级医疗中心参与者。该研究纳入了2014年1月至2017年2月入住BMT和普通内科病房的所有5,357名患者。访谈参与者包括 3 名医生、4 名护士和 4 名管理人员。干预。所有 BMT 患者均在入院 48 小时内接受筛查。根据艰难梭菌阳性聚合酶链反应 (PCR) 粪便结果定义的定植患者在住院期间均采取接触预防措施。 方法。访谈回复是根据患者安全系统工程倡议概念框架进行编码的。我们使用时间序列分析比较了 BMT 和普通内科单位干预前和干预后的 HO-CDI 率。结果。个人和组织层面的利益相关者参与有助于干预方案的标准化和优化。虽然筛查干预措施普遍受到好评，但工具和技术仍令人担忧。干预后 BMT 服务的 HO-CDI 平均发生率下降 (P < .0001)。然而，与对照病房相比，干预后趋势变化对 BMT 的影响没有显着差异 (P = .93)。结论。我们报告了第一个混合方法研究，以评估 BMT 人群中艰难梭菌筛查干预措施。一线临床工作人员、实验室工作人员和管理人员所接受的干预措施的积极性对于未来的实施研究来说是有希望的。
OBJECTIVE. To identify facilitators and barriers to implementation of a Clostridium difficile screening intervention among bone marrow transplant (BMT) patients and to evaluate the clinical effectiveness of the intervention on the rate of hospital-onset C. difficile infection (HO-CDI).DESIGN. Before-and-after trialSETTING. A 505-bed tertiary-care medical centerPARTICIPANTS. All 5,357 patients admitted to the BMT and general medicine wards from January 2014 to February 2017 were included in the study. Interview participants included 3 physicians, 4 nurses, and 4 administrators.INTERVENTION. All BMT patients were screened within 48 hours of admission. Colonized patients, as defined by a C. difficile-positive polymerase chain reaction (PCR) stool result, were placed under contact precautions for the duration of their hospital stay.METHODS. Interview responses were coded according to the Systems Engineering Initiative for Patient Safety conceptual framework. We compared pre- and postintervention HO-CDI rates on BMT and general internal medicine units using time-series analysis.RESULTS. Stakeholder engagement, at both the person and organizational level, facilitates standardization and optimization of intervention protocols. While the screening intervention was generally well received, tools and technology were sources of concern. The mean incidence of HO-CDI decreased on the BMT service postintervention (P < .0001). However, the effect of the change in the trend postintervention was not significantly different on BMT compared to the control wards (P = .93).CONCLUSIONS. We report the first mixed-methods study to evaluate a C. difficile screening intervention among the BMT population. The positive nature by which the intervention was received by front-line clinical staff, laboratory staff, and administrators is promising for future implementation studies.