Clo stridium diffic ile Asympto ma tic Ca rrie rs T he Hidde n - PowerPoint PPT Presentation

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Stochastic modeling: food would be responsible for < 1 newly �� colonized patient /1,000 adms. � ��

Asympto ma tic Ca rrie rs ��

I NCRE ASI NG I NT E RE ST ON C. DI F F I CI L E COL ONI ZAT I ON ��

CD-AC a re not a s c o nta g io us a s CDI pa tie nts… b ut a lmo st! ��

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Ho w nume ro us a re CD-AC? � ��

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Mo de ling Studie s � ��

Rapid detection of colonized patients can significantly affect the prevalence of CDI and its control, especially in the context of asymptomatic carriers and in-ward transmission. ��

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�� yping Studie s T

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ML VA to tra c k a c q uisitio n o f CDI � �� Environ. � �� sample CDI, HA � �� CD carrier CDI, Non-HA Toxin test* CD carrier * CDI test + (CCNA) but symptoms do not fulfill criteria for CDI Screening test (mainly admission) ��

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�� Future infection control measures? ��

I nstitut Unive rsita ire de Ca rdio lo g ie e t Pne umo lo g ie de Qué b e c � ��

HA-CDI ra te s, 2004-2013 ��

Co ntro l o f CDI ��

Co ntro l o f CDI �� of CD carriers in CDI � �� to �� AC � �� new set of ��

CD-AC me a sure s ��

RE AL L Y ? Can’t we just improve standard precautions? ��

C. diffic ile c a rrie r I nfe c tio n c o ntro l me a sure s ��

� Similar to CDI patients with few exceptions: � ��

�� Why not only soap and water ? Why g lo ve s?

Ha nd wa shing vs. �� C. diffic ile �� E ve n the best ha nd hyg ie ne te c hniq ue is poor ly effective to re mo ve C. diffic ile fro m ha nds! e.g. ABHRS against E. coli: 3.5 to 5 log reduction ��

E ffic a c y o f g lo ve s ��

Pro phyla xis fo r C. diffic ile c a rrie rs? � �� secondary prophylaxis � ��

De te c tio n o f c a rrie rs � ��

De te c tio n o f c arrie rs � ��

De te c tio n o f c arrie rs ��

De te c tio n o f c a rrie rs � ��

De te c tio n o f c a rrie rs ��

De te c tio n o f c a rrie rs GDH PCR ��

F a lse +? � �� gene by homebrew PCR � 396 tested; 16 ACDC detected � ��

�� S YSI ANAL

Outc o me s ��

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E xte rna l c o ntro l ��

�� He a lthc a re -Asso c ia te d CDI I nc ide nc e ra te in Que b e c , 2004-2014 ��

I nc ide nc e ra te a mo ng unive rsity ho spita ls, 2011-2012 QHLI ��

Ana lyse s �� Intervention period vs. pre-intervention period �� Poisson regression (accounts for seasonality) ��

�� S T SUL RE

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Ca rria g e ra te o n a dmissio n ��

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ARI MA mo de ling ��

Se nsitivity a na lyse s � ��

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�� Po te ntia l Co nfo unde rs

Po te ntia l Co nfo unde rs � �� Increased from 37% to 50% during intervention (p<0.001) � ��

�� use Antimic ro b ia l a nd PPI

�� Antimic ro b ia l use

Antimic ro b ia l use ��

Antimic ro b ia l a nd PPI use ��

Anti-CDI a ntimic ro b ia ls ��

I nte nsity o f CDI te sting ��

�� te sts % o f ne g a tive CDI

L ONG-T E RM F o llo w-up ��

L o ng -te rm I mpa c t �� 35.0 30.0 �� 25.0 �� 20.0 15.0 10.0 5.0 0.0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141 145 149 153 157 161 ��

L o ng -te rm I mpa c t �� 35.0 �� 30.0 �� 25.0 �� 20.0 15.0 10.0 5.0 0.0 1 5 9 13 17 21 25 29 33 37 41 45 49 53 57 61 65 69 73 77 81 85 89 93 97 101 105 109 113 117 121 125 129 133 137 141 145 149 153 157 161 ��

L o ng -te rm fo llo w-up �� QHLI ��

I mpa c t o f the I so la tio n Pre c a utio n Burde n � ��

�� Figure. Prevalence of isolation- days for C. difficile infection (CDI) or colonization April 2008- August 2016. Data presented as the number of isolation- days per 1,000 patient- days per 4- week period. Averages represent the average isolation prevalence for C. difficile for the entire periods and for the first and last 12 months of the last period. Healthcare- associated CDI incidence rates �� during each study period are presented on the lower panel. Abbreviations: CDI: Clostridium difficile infection; pd: patient- days

Pro po rtio n o f Ca rrie rs with Re c e nt Ho spita liza tio n a t the QHL I ��

�� stima te Co st-Be ne fit E

Po te ntia l �� E c o no mic Va lue ��

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Clo stridium diffic ile Asympto ma tic Ca rrie rs T he Hidde n - PowerPoint PPT Presentation

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TRAMS Wa lking diffic ulty is the mo st c o mmo n physic a l func tio na l c o mpla int re

Objec&amp;ves Proving correctness of Stable Matching algorithm Analyzing algorithms

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