Study: Thanks to COVID Precautions, C. Diff Rate Plummets

The new normal awaiting infection preventionists (IPs) and other healthcare workers when the coronavirus disease 2019 (COVID-19) pandemic recedes might not look all that different from what’s going on now when it comes to steps being taken to reduce infection: a greater attention hand hygiene, social distancing, masking, and the proper donning and doffing of personal protective equipment (PPE). Or it shouldn’t look that different, a pre-print study in the American Journal of Infection Control suggests.1 That’s because investigators with Sant’Andrea University Hospital of Rome found that the incidence of Clostridium difficile went down substantially in 2020, compared to 2017, 2018, and 2019.

Investigators also say that their findings might suggest that SARS-CoV-2 might actually cause C. diff. Investigators looked at data on 1617 people discharged from the hospital from March 1 to June 30 to discharge data from 2017, 2018, and 2019. The presence of C. diff was noted by stool examination and/or if someone had diarrhea more than 3 times in a 24-hour period. Intensive care and pediatric wards were excluded from the data collection.

While investigators found that there was no statistically significant difference in C. diff incidence in 2017, 2018, and 2019, this year proved to be quite different.

“Interestingly,” the study states, “during 2020, COVID-19 departments showed higher [C. diff] incidence in respect to Covid-19 free wards (not significative). This data suggests SARS-Cov2 infection as a possible risk factor for [C. diff] in agreement with recent evidences that report altered gut microbiota in COVID-19 patients.”

C. diff was significantly reduced in 2020 compared to 2017 (odds ratio [OR] = 2,98; P = .002), 2018 (OD = 2.27; P = .023) and 2019 (OD = 2,07; P = .047).

The investigators note that C. diff is the most common pathogen among healthcare-acquired infections (HAIs), increasing from 4.5 patients per 1000 discharges in 2001, to 8.2 patients per 1000 discharges in 2010. C. diff adds $1.5 in healthcare costs in the United States each year. They also note the dearth of evidence that contact precautions, proper PPE usage, and knowledge of hand hygiene among healthcare workers actually helps to prevent C. diff spread.

But when COVID-19 struck, the proper use of PPE and greater attention to hand hygiene and cleaning surfaces became the norm. In addition, with Sant’Andrea University Hospital also put limits on how many relatives could visit patients and for how long. In addition, relatives had to wear PPE as well.

Investigators could not determine which one of the measures adopted because of COVID played the biggest role in slowing C. diff spread but note that previous studies have shown that hand hygiene alone wasn’t enough.

“We can therefore speculate that all practices described above adopted in their complex along with greater attention payed by health personnel have led to lower [C. diff] spread,” the study states. It also notes that “health workers hygiene errors are at the base of microorganism spread in a hospital setting: in particular, protocol deviations during PPE donning and doffing are common and cause self-contamination. The COVID-19 emergency has led to extraordinary levels of attention by all healthcare personnel regarding control activities related to prevention of microorganism transmission. This study demonstrates that maintaining this level of preventive measure over time would significantly reduce [C. diff] and related expenses in terms of health costs and human lives.”