Comparing intervention strategies for reducing Clostridioides difficile transmission in acute healthcare settings: an agent-based modeling study

• Published in: BMC infectious diseases 2020-10, Vol.20 (1), p.799-17, Article 799
• Main Authors: Stephenson, Brittany, Lanzas, Cristina, Lenhart, Suzanne, Ponce, Eduardo, Bintz, Jason, Dubberke, Erik R, Day, Judy
• Format: Article
• Language: English
• Subjects: Agent-based model; Agent-based models; Anti-Bacterial Agents - therapeutic use; Antibiotics; Antiinfectives and antibacterials; Antimicrobial Stewardship; Asymptomatic; Clostridioides difficile; Clostridioides difficile - drug effects; Clostridioides difficile - immunology; Clostridium infections; Clostridium Infections - drug therapy; Clostridium Infections - microbiology; Clostridium Infections - prevention & control; Clostridium Infections - transmission; Colonization; Comparative analysis; Contamination; Cross Infection - microbiology; Cross Infection - prevention & control; Cross Infection - transmission; Decontamination; Environmental transmission; Evaluation; Hand Hygiene; Health care; Health Personnel; Healthcare; Humans; Hygiene; Infection control; Infection Control - methods; Mathematical analysis; Mathematical models; Medical personnel; Microbiota; Models, Theoretical; Nosocomial infections; Pathogens; Patients; Personal hygiene; Prevention; Public health administration; Reduction; Risk levels; Stochastic model; Systems Analysis; Vaccination; Vaccines; Vectors; Vectors (mathematics)
• ISSN: 1471-2334; 1471-2334
• DOI: 10.1186/s12879-020-05501-w

Clostridioides difficile infection (CDI) is one of the most common healthcare infections. Common strategies aiming at controlling CDI include antibiotic stewardship, environmental decontamination, and improved hand hygiene and contact precautions. Mathematical models provide a framework to evaluate control strategies. Our objective is to evaluate the effectiveness of control strategies in decreasing C. difficile colonization and infection using an agent-based model in an acute healthcare setting. We developed an agent-based model that simulates the transmission of C. difficile in medical wards. This model explicitly incorporates healthcare workers (HCWs) as vectors of transmission, tracks individual patient antibiotic histories, incorporates varying risk levels of antibiotics with respect to CDI susceptibility, and tracks contamination levels of ward rooms by C. difficile. Interventions include two forms of antimicrobial stewardship, increased environmental decontamination through room cleaning, improved HCW compliance, and a preliminary assessment of vaccination. Increased HCW compliance with CDI patients was ranked as the most effective intervention in decreasing colonizations, with reductions up to 56%. Antibiotic stewardship practices were highly ranked after contact precaution compliance. Vaccination and reduction of high-risk antibiotics were the most effective intervention in decreasing CDI. Vaccination reduced CDI cases to up to 90%, and the reduction of high-risk antibiotics decreased CDI cases up to 23%. Overall, interventions that decrease patient susceptibility to colonization by C. difficile, such as antibiotic stewardship, were the most effective interventions in reducing both colonizations and CDI cases.