VIII Congresso Nazionale Maggio 2018
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1 VIII Congresso Nazionale Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie Maggio 2018 Bergamo, Ospedale Papa Giovanni XXIII Clostridium difficile Quali novità emergono dalle recenti linee guida rispetto al documento di indirizzo SIMPIOS 2011 in termini di prevenzione, diagnosi e terapia delle Infezioni da Clostridium difficile? Dr. Andrea Patroni
2 2011
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5 2018
6 EPIDEMIOLOGY I. How are CDI cases best defined?
7 EPIDEMIOLOGY II. What is the minimal surveillance recommendation for institutions with limited resources?
8 EPIDEMIOLOGY III. What is the best way to express CDI incidence and rates?
9 EPIDEMIOLOGY IV. How should CDI surveillance be approached in settings of high endemic rates or outbreaks? II. Surveillance Does surveillance of CDI in combination with appropriate feedback of infection rates lead to reduced CDI rates?
10 EPIDEMIOLOGY V. What is the recommended CDI surveillance strategy for pediatric institutions?
11 DIAGNOSIS VI. What is the preferred population for C. difficile testing, and should efforts be made to achieve this target?
12 DIAGNOSIS VII. What is the best-performing method for detecting patients at increased risk for clinically significant C. difficile infection in community submitted stool specimens? I. Diagnostic approach for prevention of transmission
13 DIAGNOSIS VIII. What is the most sensitive method of diagnosis of CDI in stool specimens from patients likely to have CDI based on clinical simptoms? I. Diagnostic approach for prevention of transmission
14 DIAGNOSIS IX. What is the role of repeat testing, if any? Are there asymptomatic patients in whom repeat testing should be allowed, including test of cure?
15 DIAGNOSIS X. Does detection of fecal lactoferrin or another biologic marker improve the diagnosis of CDI over and above the detection of toxigenic C. difficile Can such a subset predict a more ill cohort?
16 DIAGNOSIS XI. When should a neonate or infant be tested for C. difficile?
17 DIAGNOSIS XII. When should a toddler or older child be tested for C. difficile?
18 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XIII. Should private rooms and/or dedicated toilet facilities be used for isolated patients with CDI? VIII. Infrastructure Are infrastructural changes effective in reducing transmission of C. difficile in hospitals?
19 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XIV. Should gloves and gowns be worn while caring for isolated CDI patients? V. Personal protective equipment (PPE) How effective is the additional use of personal protective equipment (PPE) in reducing C. difficile infection/transmission, compared to standard precautions only?
20 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XV. When should isolation be implemented? VI. Contact precautions Are contact precautions for CDI patients effective in reducing the CDI rate/transmission of C. difficile in hospital settings?
21 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XVI. How long should isolation be continued?
22 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XVII. What is the recommended hand hygiene method (assuming glove use) when caring for patients in isolation for CDI? IV. Hand hygiene Which are the most effective techniques/products for removal of C. difficile or its spores from hands?
23 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XVII. What is the recommended hand hygiene method (assuming glove use) when caring for patients in isolation for CDI? IV. Hand hygiene Is ethanol-based habd rub associated with increased CDI rates compared with hand washing?
24 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XVIII.Should patient bathing interventions be implemented to prevent CDI? IV. Hand hygiene Is hand hygiene compliance associated with CDI transmission?
25 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XIX. Should noncritical devices or equipment be dedicated to or specially cleaned after being used on the isolated patient with CDI?
26 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XX. What is the role of manual, terminal disinfection using a C. difficile sporacidal agent for patients in isolation for CDI? VII. Environmental cleaning and disinfection Does environmental disinfection of rooms of patients with CDI decrease the transmission of C. difficile compared with routine cleaning?
27 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXI. Should cleaning adequacy be evaluated? VII. Environmental cleaning and disinfection Are no-touch disinfection systems as effective as hypochlorite to reduce the environmental contamination in rooms of patients with CDI?
28 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXII. What is the role of automated terminal disinfection using a method that is sporicidal against C. difficile? VII. Environmental cleaning and disinfection Are no-touch disinfection systems effective in reducing transmission/incidence of C. difficile?
29 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXIII. What is the role of daily sporicidal disinfection? VII. Environmental cleaning and disinfection Does environmental disinfection of rooms of patients with CDI decrease the transmission of C. difficile compared with routine cleaning?
30 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXIV. Should asymptomatic carriers of C. difficile be identified and isolated if positive? III. Screening of asymptomatic patients and healthcare workers for C. difficile carriage Does screening for C. difficile identify colonised/carrier patients at increased or decreased risk of developing C. difficile infection?
31 III. Screening of asymptomatic patients and healthcare workers for C. difficile carriage Are healthcare workers with contact to C. difficilepositive patients at risk for asymptomatic colonization or infection with C. difficile and should screening of healthcare workers for carriage of C. difficile to reduce CDI rates be reccommended?
32 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXV. What is the role of antibiotic stewardship in controlling CDI rates? IX. Antibiotic stewardship Is restriction of antibiotic agents/classes effective in reducing CDI rate in hospitals?
33 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXV. What is the role of antibiotic stewardship in controlling CDI rates? IX. Antibiotic stewardship Is reducing length of antibiotic therapy effective in reducing CDI rates in hospitals?
34 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXVI. What is the role of proton pump inhibitor restriction in controlling CDI rates?
35 PREVENTION AND CONTROL Isolation Measures for Patients With CDI XXVII. What is the role of probiotics in primary prevention of CDI?
36 TREATMENT XXVIII. What are important ancillary treatment strategies for CDI? X. Early treatment (focus on prevention of transmission) Can early treatment of suspected/diagnosed patients with CDI reduce the transmission of C. difficile?
37 TREATMENT XXIX. What are the best treatment of an iniatial CDI episode to ensure resolution of symptoms and sustained resolution 1 month after treatment? XXX. What ate the best treatments of fulminant CDI? XXXI. What are the best treatments for recurrent CDI?
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39 TREATMENT (Pediatric considerations) XXXII. What is the best treatment of an initial episode or fist recurrence of nonsevere CDI in children? XXXIII. What is the best treatment of an initial episode of severe CDI in children? XXXIV. What is the best treatments for a second or greater episode of recurrent CDI in children? XXXV. Is there a role for fecal microbiota transplantation in children with recurrent CDI?
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41 XI. Education Is specific education required to enhance knowledge regarding prevention od CDI?
42 XI. Education How does implementation of intensified teaching, e-learning, direct observation, testing influence C. difficile transmission/prevalence in hospitals?
43 XI. Education Does specific education enhance thoroughness of cleaning in the context of CDI prevention?
44 XI. Education Should CDI patients and visitors be educated on prevention measures for CDI?
45 Quindi
46 VIII Congresso Nazionale Attualità e prospettive nella prevenzione e controllo delle infezioni nelle organizzazioni sanitarie Maggio 2018 Bergamo, Ospedale Papa Giovanni XXIII Grazie!
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