Effectiveness of Isolating Clostridium Difficile Asymptomatic Carriers on the Incidence of Infections (EFFICACI)
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|ClinicalTrials.gov Identifier: NCT03223415|
Recruitment Status : Completed
First Posted : July 21, 2017
Last Update Posted : September 29, 2020
Background: There is an urgent need to develop new strategies to prevent Clostridium difficile infections (CDI). A recent study suggests that a novel infection control bundle (IC bundle) can lead to a significant decrease in the incidence of CDI in acute-care hospitals. This IC bundle consists in screening patients for C. difficile carriage upon their admission combined with implementation of isolation precautions for carriers. Further investigations are required to confirm these findings.
Objective: To evaluate the feasibility of implementing a multicenter interventional study to further to investigate the efficacy of this IC bundle.
Methods: Prospective, cluster randomized feasibility trial of 2 infection control strategies (a "standard" and an "experimental" strategy) to reduce transmission of C. difficile among patients in 20 medical wards in 5 acute-care facilities in Quebec. Wards will be randomized (1:1) to one of the 2 interventions. Each intervention will be applied to all patients present on selected wards. The study will be divided into (1) a 3-month baseline period; (2) a 2-week randomization and implementation period; and (3) an 8-week intervention period.
Intervention: The "experimental strategy" includes the components of the above-mentioned IC bundle. The "standard strategy" will not implement the IC bundle.
Outcomes: As a feasibility study, process evaluation will form the primary and secondary outcomes. These outcomes will allow to determine whether a future main trial is possible and desirable.
Hypothesis: We hypothesize that the intervention will be implementable across the study wards.
Significance: This study is essential to plan a subsequent definitive trial to determine whether the IC bundle can prevent CDI.
|Condition or disease||Intervention/treatment||Phase|
|Clostridium Difficile||Other: Detection and isolation of C. difficile carriers||Not Applicable|
C. difficile is a gram-negative anaerobic bacteria that causes C. difficile infection (CDI), a disease involving the colon and causing symptoms ranging from mild diarrhea to fulminant colitis. C. difficile can spread from patients to patients in acute-care hospitals. Transmission is believed to occur mainly from patients with active disease, but patients who carry the bacteria without any symptom (called C. difficile carriers) can also transmit the bacteria to other patients.
Preliminary evidence that suggest that detecting C. difficile carriers to place them under isolation precautions can lead to a decrease in the incidence of CDI. In order to investigate this question, large-scale clinical trials will be ultimately required. In order to plan such large-scale study, there is a need to perform a preliminary feasibility trial. The current study will assess the feasibility, acceptability and logistical considerations of implementing a multicenter intervention consisting of the detection and isolation of C. difficile carriers on hospital admission, in order to guide the design of a definitive trial. This objective is essential considering the paucity of published data on this topic.
|Study Type :||Interventional (Clinical Trial)|
|Actual Enrollment :||4138 participants|
|Intervention Model:||Parallel Assignment|
|Masking:||None (Open Label)|
|Official Title:||Effectiveness of Isolating Clostridium Difficile Asymptomatic Carriers on the Incidence of Infections; A Cluster Randomized Feasibility Trial|
|Actual Study Start Date :||August 25, 2017|
|Actual Primary Completion Date :||April 1, 2018|
|Actual Study Completion Date :||May 2, 2018|
Experimental: Experimental arm
Detection and isolation of C. difficile carriers
Other: Detection and isolation of C. difficile carriers
Screening for C. difficile carriage will be conducted by performing a polymerase chain reaction (PCR) assay detecting the toxin B gene (tcdB) on a rectal swab. Screening will occur within 24 h of admission to the ward. To ensure compliance with the policy, automatic orders will be developed. The patient care nurse will perform the screenings. The results will be reported according to the standard institutional policy.
Isolation precautions for C. difficile carriers: healthcare workers will also follow a set of isolation precaution rules during the care of C. difficile carriers. C. difficile carriers will remain under isolation precaution as long as they remain carriers and on the intervention ward. Precautions would be discontinued upon discharge from the ward.
No Intervention: Control arm
No detection of C. difficile carriers upon admission and no implementation of contact isolation precautions for C. difficile carriers
- Rate of admission screening for C. difficile carriage [ Time Frame: 8 weeks ]Rate of admission screening for C. difficile carriage, defined as the number of patients who were screened on admission divided by the number of admitted patients per 4-week period
- Healthcare worker compliance with the isolation precautions [ Time Frame: 8 weeks ]Healthcare worker compliance with the isolation precautions, defined as the number of opportunities in which healthcare workers complied with the isolation precaution upon entering the room of a C. difficile carrier divided by the total number of healthcare workers who entered the room.
- Rate of rejection of screening assays [ Time Frame: 8 weeks ]Rate of rejection of rectal swabs, defined as the number of rectal swabs submitted to the laboratory for C. difficile screening assay that were rejected for any reason divided by the total number of rectal swabs submitted for C. difficile screening assay per 4-week period.
- Healthcare worker compliance with hand washing [ Time Frame: 8 weeks ]Healthcare worker compliance with hand washing, defined as the number of opportunities in which healthcare workers complied with the hand washing policy upon exiting the room of a C. difficile carrier divided by the total number of hand washing opportunities upon exiting the room of a C. difficile carrier.
- Proportion of screening assays with proper turnaround time [ Time Frame: 8 weeks ]Proportion of screening assays with proper turnaround time, defined as the number of screening samples with a < 24 hour turnaround time (TAT) divided by the number of screening samples submitted to the laboratory.
To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.
Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT03223415
|Hopital Charles Lemoyne|
|Greenfield Park, Quebec, Canada, J4V 2H1|
|Montreal General Hospital|
|Montreal, Quebec, Canada, H3G 1A4|
|McGill University Health Center|
|Montreal, Quebec, Canada, H4A 3J1|
|Jewish General Hospital|
|Montréal, Quebec, Canada, H3S 1Y9|
|Centre Hospitalier Sainte-Marie|
|Trois-Rivières, Quebec, Canada, G8Z 3R9|
|Principal Investigator:||Yves Longtin, MD||Sir Mortimer B. Davis - Jewish General Hospital|