Disinfectant Linked With Reduced Hospital-Onset Clostridioides difficile Infection

Hospital ward cleaning with potassium peroxymonosulphate-based environmental disinfectant (PPED) and a decrease in days of therapy with carbapenems were associated with a reduction in the rate of hospital-onset Clostridioides difficile infection (CDI), according to study findings published in the Journal of Hospital Infection.

The diarrhea-causing pathogen Clostridioides difficile has been linked with potentially life-threatening damage to the colon. The hospital setting’s long-standing presence of endospores has been indicated to contribute to nosocomial outbreaks of CDI, in which frequent use of broad-spectrum antimicrobials, such as carbapenems, fluoroquinolones, and third or fourth generation cephalosporin serve as risk factors.

“Antimicrobial stewardship (AS) can be used to reduce hospital-onset CDI. PPED is used in hospital environments as a countermeasure against infection with multi-drug resistant bacteria, norovirus and SARS-CoV-2, and has been used in many medical facilities in Japan under certain conditions,” said the study authors.

“A 1% PPED produces sodium hypochlorite when combined with sodium chloride, which functions as a disinfectant. However, little is known about the effect of hospital cleaning with PPED on hospital-onset CDI.”

Researchers conducted a retrospective, single-center study at the Tosei General Hospital in Aichi, Japan, to evaluate the impact of promoting antimicrobial stewardship and hospital ward cleaning with PPED on hospital-onset CDI.

The ratio of hospital-onset CDI, PPED consumption, and days of therapy of broad-spectrum antimicrobials were assessed between July 2014 and March 2018, in which this time was divided into prepromotion (July 2014 to June 2015) and post-promotion periods (July 2015 to March 2018).

From the prepromotion to the post-promotion period, hospital-onset CDI significantly decreased from 13.5 (interquartile range [IQR], 11.8-15.0) to 6.94 (IQR, 5.00-9.25), PPED consumption increased from 84.0 (IQR, 75.4-85.6) to 135.7 (IQR, 114.8-151.4), and days of therapy of carbapenems significantly decreased from 63.0 (IQR, 59.5-68.2) to 41.4 (IQR, 36.0-47.6). Use of other antimicrobials, including broad-spectrum antimicrobials, did not increase or decrease significantly.

Using interrupted time series analysis, an immediate significant change was observed (P = .03) after intervention, but no downward trend in hospital-onset CDI was observed over this period (slope change, 0.09 to –2.78; P = 0.19). Trends in PPED consumption significantly changed over this period (P = .02) and days of therapy of carbapenems decreased immediately after the intervention began (P < .01).

Regarding variables affecting the ratio of hospital-onset CDI, Poisson regression analysis findings showed that PPED consumption (incidence rate ratio [IRR], 0.886; 95% CI, 0.790-0.994; P = .039) and days of therapy of carbapenems (IRR, 1.025; 95% CI, 1.005-1.046; P = .016) were independent factors.

As the first study reporting the impact of hospital ward cleaning with PPED on the reduction of hospital-onset CDI, researchers concluded that subsequent multicenter prospective intervention studies are warranted to confirm findings.

Reference

Umemura T, Mutoh Y, Masayuki M, et al. Impact of hospital environmental cleaning with a potassium peroxymonosulphate-based environmental disinfectant and antimicrobial stewardship on the reduction of hospital-onset Clostridioides difficile infections. ​​J Hosp Infect. 2022 Jul 9;S0195-6701(22)00219-5. doi:10.1016/j.jhin.2022.06.018