COVID-19 Pandemic Response the Blueprint for Reducing C Difficile Impact


Multiple studies have found a decrease in CDI rates during the COVID-19 pandemic in comparison to previous years.

As the COVID-19 pandemic swept through the US during the early part of 2020, like any other business, hospitals adopted several measures to reduce the risk of viral spread.

Whether it is social distancing requirements, masking regulations, enhanced sanitation, or daily deep cleanings, hospitals tried anything they could to try to limit the spread of COVID-19.

And while these measures did have an impact on reducing COVID-19 spread, they may have had a greater impact at reducing other viral infections, such as clostridium difficile infections (CDI).

While there has been a lot of focus on the drastic decrease in the community spread of influenza to the point where there was less than 3000 confirmed cases during the most recent flu season, there have been multiple studies and retrospective examinations recently showing that c difficile cases largely decreased because of the enhanced hospital measurements.

“This pandemic has led to a number of amazing findings that are either not so good or good,” Brian E. Lacy, MD, PhD, Gastroenterology, Neurogastroenterology, the Mayo Clinic said. “As an example, not so good is we are spending huge amounts of money now on protective gear and resources that maybe we could have employed in a better way.”

However, Lacy said what was learned about public health during the pandemic might be invaluable.

“We’ve also learned some really neat things,” Lacy said. “With fewer people coming into the hospital we’re not spreading diseases in the hospital as much. I hope we take some of these lessons about hand washing and we’re gloves more frequently and wearing masks to heart because I think we can really improve the health of our patients who are already in the hospital in the years to come.”

How C Difficile Spreads

CDI is currently the leading cause of hospital-acquired infectious diarrhea worldwide, with high bed occupancy rates in acute hospitals correlating with an increase in healthcare-associated CDI (HA-CDI).

During the recent 2021 Digestive Disease Week Virtual Meeting, Alpesh N. Amin, MD, Chair of the Department of Medicine and Executive Director of the Hospitalist Program at the University of California Irvine School of Medicine, said stopping the spread of infectious disease requires both policy and behavioral changes.

C. difficile infections are acquired largely in 1 of 2 ways—either the exposure of antibiotics that puts patients at a risk of acquiring the infection or through spores and the propagation of person-to-person transmission.

Both these occurrences are at an enhanced risk in the hospital setting.

“So this propagation issue, we’ve been more vigilant in hospitals due to COVID that folks are more attune to,” Amin said. “The question is post COVID will our behavior maintain itself and therefore facilitate a decrease in propagation of spores and infections. I don’t know the answer for sure but I’m hopeful.”

Data on the Decrease

In data was presented during the 2021 Digestive Disease Week (DDW) Virtual Conference, a research team from Beaumont Hospital found these new hospital regulations, including improved hand-hygiene, increased use of personal protective equipment (PPE), social distancing, and reduced hospital occupancy drastically reduced the rates of the hospital acquired infection.

The researchers compared C. difficile rates during the first wave of the pandemic between March and May 2020 and compared the rates to the same time periods in 2018 and 2019 using a database of CDI.

In another study published earlier this year, researchers led by led by Jessica R. Allegretti, Division of Gastroenterology, Hepatology and Endoscopy, Brigham and Women's Hospital, examined hospitalized COVID-19 patients from 9 hospitals in Massachusetts and found rates of confirmed CDI were lower among this patient cohort.

Overall, there were 97 (24.9%) patients who were tested for CDI, with a mean age of 62.4 years old. Of this group, 5 (5.2%) patients tested positive for CDI, which was lower than the overall inpatient CDI-positive rate in 2019 (n = 280; 9.8% of tests performed). However, this difference was not considered statistically significant.

Data from the 2020 American College of Gastroenterology (ACG) annual conference also showed CDI rates decreased in both proportion and number among hospital inpatients during the peak pandemic months.

Investigators from the University of Virginia Health System wrote that C. diff infections are common, although from 2011 to 2017 there was a noted decline in the spread of the disease. However, many health care systems have noted a dramatic shift in C. diff infections and infection control throughout the COVID-19 pandemic.

In November, December, January, and February, there were 2159, 2233, 2314, and 2088 inpatient admissions respectively compared to 1786, 1421, and 1876, respectively, in March, April, and May using data from a single center study.

Future Decisions

While some measures might be here to stay, other changes to health care during the pandemic, such as the cessation of elective procedures and reduced presentations of non-COVID-19 related illnesses almost certainly will be reversed next year.

But as the threat of COVID-19 decreases over time and the public pushes back on all pandemic-related interventions, hospitals may be one of the few locations that never go back to pre-COVID ways of life.

Joshua Bender, a medical student at Columbia University Vagelos College of Physicians and Surgeons, hoped the lessons learned during the pandemic will remain throughout the duration of his career.

“As a country, as a world, we’ve learned so much about basic public health measures to prevent the spread of disease,” Bender told HCPLive®. “Obviously I think the big one has been wearing masks and how that’s been credited with decreasing COVID cases, but also flu and other infectious disease. I don’t know what it’s going to look like going forward, but I think that everyone has become much more comfortable wearing this personal protective gear.”

Bender said will this in place he expects the threat hospital-acquired infections to ultimately decrease.

“I don’t make the policy, but I’m excited to see what we do decide once we get further past COVID,” he said. “I think that could certainly have a really big benefit for the population at large.”

Short Memories

However, while everyone is hopeful the pandemic offers up a chance to learn and make improvements to public health, there is the possibility that the ongoing COVID-19 saga could end up a wasted learning opportunity.

“The problem is that people’s memories are sometimes short-lived when it comes to behavioral changes,” Amin said. “The innovation that I tend to look at is can we create barriers and structural things that will facilitate the cultural and behavioral things that we need to have in order to ensure long-term sustainability.”

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