Reducing C. difficile in children: An agent-based modeling approach to evaluate intervention effectiveness

Area of Science:

• Infectious Diseases
• Hospital Epidemiology
• Public Health

Background:

• Clostridioides difficile infection (CDI) is a growing concern in pediatric healthcare settings.
• Effective infection prevention strategies are crucial to mitigate CDI transmission and colonization.

Purpose of the Study:

• To evaluate the efficacy of various infection prevention interventions and bundles in reducing hospital-onset CDI and asymptomatic C. difficile colonization in children's hospitals.
• To identify the most effective strategies for controlling CDI in pediatric inpatient environments.

Main Methods:

• An agent-based simulation model was developed to mimic C. difficile transmission dynamics in a simulated pediatric hospital.
• The model incorporated patient, visitor, and healthcare worker (HCW) agent types and simulated various infection prevention interventions.
• Key interventions included environmental disinfection, admission screening, hand hygiene, and reduced patient transfers.

Main Results:

• A combination of daily environmental disinfection with a sporicidal product and admission screening for asymptomatic C. difficile carriers demonstrated the highest effectiveness.
• This bundle reduced hospital-onset CDI by 62.0% and asymptomatic colonization by 88.4%.
• Several single interventions, such as daily disinfection, terminal disinfection, admission screening, HCW hand hygiene, patient hand hygiene, and reduced patient transfers, also showed significant reductions.

Conclusions:

• Hospitals can achieve substantial reductions in hospital-onset CDI by implementing a select few highly effective interventions.
• Targeted infection prevention bundles, particularly those involving environmental disinfection and screening, are key to controlling CDI in pediatric populations.