Reducing length of stay to improve Clostridium difficile-related health outcomes

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Brain D.C., Barnett A.G., Yakob L., Clements A., Riley T.V., Halton K., Graves N. (2018) Reducing length of stay to improve Clostridium difficile-related health outcomes. Infection, Disease and Health. Published online ahead of print: DOI: 1016/j.idh.2018.01.001


Background: Clostridium difficile infection is a serious hospital-acquired infection, causing negative outcomes for those who are afflicted by it. Hospital length of stay is known to be a risk factor for transmission and significant reductions in infection numbers can be realised if transmission is reduced.

Methods: A Markov model was constructed to compare the impact that five alternative healthcare scenarios had on total C. difficile infections, QALYs gained and total number of patients requiring treatment in ICU. A previously published stochastic transmission model for C. difficile informed scenario effectiveness, while other parameters were estimated from published literature, administrative datasets and expert opinion.

Results: Reducing inpatient LOS disrupts transmission of C. difficile and results in a large reduction of total infections. In turn, an increase in QALYs is expected when the number of infections is reduced. A reduction in infections reduces the number of ICU admissions, which is likely to have a large economic benefit in the Australian setting. Coupling a reduction in overall inpatient LOS with a ‘traditional’ infection control intervention, such as hand hygiene or antimicrobial stewardship, improves results further than reducing LOS on its own.

Conclusion: Implementing a LOS-focused intervention would be a practical challenge, especially for clinicians who already juggle high demand. However, it is not unattainable with the right local endorsement and could have significant benefits for health services.