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point-counterpoint: what is the optimal approach for detection of clostridium difficile infection?introductionin 2010, we published an initial point-counterpoint on the laboratory diagnosis of clostridium difficile infection (cdi). at that time, nucleic acid amplification tests (naats) were just becoming commercially available, and the idea of algorithmic approaches to cdi was being explored. now, there are numerous naats in the marketplace, and based on recent proficiency test surveys, they have become the predominant method used for cdi diagnosis in the united states. at the same time, the ...201728077697
investigation of community carriage rates of clostridium difficile and hungatella hathewayi in healthy volunteers from four regions of england.faecal samples from 1365 healthy asymptomatic volunteers from four regions in england were screened for the presence of clostridium difficile between december 2013 and july 2014. the carriage rate of c. difficile in healthy patients was 0.5%, which is lower than reported previously. this study demonstrates that the true community reservoir of c. difficile in the healthy uk population is very low and is, therefore, unlikely to be a reservoir for infections diagnosed in the hospital setting.201728549779
second generation cephalosporin antibiotic prophylaxis and clostridium difficile infection in hip and knee arthroplasty.introduction the use of broad spectrum cephalosporin antibiotics has been discouraged by the department of health in england because of the link to increased clostridium difficile infection rates. the aim of this study was to evaluate whether a local protocol that included the use of second generation cephalosporin (cefuroxime) antibiotics as a prophylactic agent was associated with increased risk of c difficile in elective hip and knee arthroplasty patients. methods a retrospective intention-to ...201728462657
toxigenic clostridium difficile colonization among hospitalised adults; risk factors and impact on survival.to establish risk factors for clostridium difficile colonization among hospitalized patients in england.201728435086
comparative epidemiology of clostridium difficile infection: england and the usa.to examine whether there is an epidemiological difference between clostridium difficile infection (cdi) inpatient populations in england and the united states.201729025123
bed utilisation and increased risk of clostridium difficile infections in acute hospitals in england in 2013/2014.the study aimed to identify thresholds for hospital bed utilisation which are independently associated with significantly higher risks for clostridium difficile infections (cdi) in acute hospitals in england.201627601687
interview with professor mark wilcox.mark wilcox speaks to georgia patey, commissioning editor: professor mark wilcox is a consultant microbiologist and head of microbiology at the leeds teaching hospitals (leeds, uk), the professor of medical microbiology at the university of leeds (leeds, uk), and is the lead on clostridium difficile and the head of the uk c. difficile reference laboratory for public health england (phe). he was the director of infection prevention (4 years), infection control doctor (8 years) and clinical direct ...201627494150
enhanced surveillance of clostridium difficile infection occurring outside hospital, england, 2011 to 2013.there are limited national epidemiological data for community-associated (ca)-clostridium difficile infections (cdis). between march 2011 and march 2013, laboratories in england submitted to the clostridium difficile ribotyping network (cdrn) up to 10 diarrhoeal faecal samples from successive patients with ca-cdi, defined here as c. difficile toxin-positive diarrhoea commencing outside hospital (or less than 48 hours after hospital admission), including those cases associated with community-base ...201627487436
polonium-210 poisoning: a first-hand account.polonium-210 ((210)po) gained widespread notoriety after the poisoning and subsequent death of mr alexander litvinenko in london, uk, in 2006. exposure to (210)po resulted initially in a clinical course that was indistinguishable from infection or exposure to chemical toxins, such as thallium.201627461439
uk renal registry 18th annual report: chapter 12 epidemiology of reported infections amongst patients receiving dialysis for established renal failure in england 2013 to 2014: a joint report from public health england and the uk renal registry.from 1st may 2013 to 30th april 2014 there were 35 episodes of methicillin resistant staphylococcus aureus (mrsa) bacteraemia in established renal failure patients on dialysis. this is now fairly stable year-on-year equating to a rate of 0.15 episodes per 100 dialysis patient years, following an initial decline in rates from 4.0 episodes per 100 dialysis patient years in 2005 when reporting began. methicillin sensitive staphylococcus aureus (mssa) bacteraemia rates were slightly higher this year ...201627116291
the impact of the introduction of fidaxomicin on the management of clostridium difficile infection in seven nhs secondary care hospitals in england: a series of local service evaluations.clostridium difficile infection (cdi) is associated with high mortality. reducing incidence is a priority for patients, clinicians, the national health service (nhs) and public health england alike. in june 2012, fidaxomicin (fdx) was launched for the treatment of adults with cdi. the objective of this evaluation was to collect robust real-world data to understand the effectiveness of fdx in routine practice. in seven hospitals introducing fdx between july 2012 and july 2013, data were collected ...201626661400
genomic epidemiology of a protracted hospital outbreak caused by a toxin a-negative clostridium difficile sublineage pcr ribotype 017 strain in london, england.clostridium difficile remains the leading cause of nosocomial diarrhea worldwide, which is largely considered to be due to the production of two potent toxins: tcda and tcdb. however, pcr ribotype (rt) 017, one of five clonal lineages of human virulent c. difficile, lacks tcda expression but causes widespread disease. whole-genome sequencing was applied to 35 isolates from hospitalized patients with c. difficile infection (cdi) and two environmental ward isolates in london, england. the phylogen ...201526179308
management of patients with suspected infectious diarrhoea in hospitals in england.advances in molecular and genomic testing for patients with suspected infectious diarrhoea are on the horizon. it is important to understand how infection control and microbiology departments currently operate with respect to the management of these patients in order to assess the implications of more widespread diagnostic testing. however, there are few data available on current practice in this context.201525997802
clostridium difficile toxin testing by national health service (nhs) acute trusts in england: 2008-2013.in october 2007, a governmental 3-year target to reduce clostridium difficile infection (cdi) by 30%, with financial penalties levied for failure, was introduced in england. this target was met within just 1 year, leading to speculation of 'gaming', with hospitals empirically treating possible cdi in the absence of a microbiological diagnosis, to avoid having to report confirmed cases. an analysis of aggregate mandatory data on levels of testing for c. difficile toxin showed little evidence of a ...201525964154
antibiotic policies in acute english nhs trusts: implementation of 'start smart-then focus' and relationship with clostridium difficile infection rates.the objective of this study was to establish how antibiotic prescribing policies at national health service (nhs) hospitals match the england department of health 'start smart-then focus' recommendations and relate to clostridium difficile infection (cdi) rates.201525538165
analysis of interventions to reduce the incidence of clostridium difficile infection at a london teaching hospital trust, 2003-2011.since 2008 there has been a substantial fall in the incidence of clostridium difficile infection (cdi) in the uk, though it is unclear what contribution local and governmental interventions have made to this reduction.201525480022
longitudinal trends and cross-sectional analysis of english national hospital antibacterial use over 5 years (2008-13): working towards hospital prescribing quality measures.there is global concern that antimicrobial resistance is a major threat to healthcare. antimicrobial use is a primary driver of resistance but little information exists about the variation in antimicrobial use in individual hospitals in england over time or comparative use between hospitals. the objective of this study was to collate, analyse and report issue data from pharmacy records of 158 national health service (nhs) acute hospitals.201525304646
nosocomial transmission of c. difficile in english hospitals from patients with symptomatic infection.recent evidence suggests that less than one-quarter of patients with symptomatic nosocomial clostridium difficile infections (cdi) are linked to other in-patients. however, this evidence was limited to one geographic area. we aimed to investigate the level of symptomatic cdi transmission in hospitals located across england from 2008 to 2012.201424932484
international prevalence of adverse drug events in hospitals: an analysis of routine data from england, germany, and the usa.adverse drug events (ades) are frequent in hospitals, occurring either in patients before admission or as a nosocomial event, and either as a drug reaction or as a consequence of a medication error. routine data primarily recorded for reimbursement purposes are increasingly being used on a national level both in pharmacoepidemiological studies and in trigger tools. the aim of this study was to compare the prevalence rates of coded ades in hospitals on a transnational level.201424620750
impact of cleaning and other interventions on the reduction of hospital-acquired clostridium difficile infections in two hospitals in england assessed using a breakpoint model.clostridium difficile infection remains a major challenge for hospitals. although targeted infection control initiatives have been shown to be effective in reducing the incidence of hospital-acquired c. difficile infection, there is little evidence available to assess the effectiveness of specific interventions.201323787167
uk renal registry 16th annual report: chapter 15 epidemiology of reported infections amongst patients receiving dialysis for established renal failure in england from may 2011 to april 2012: a joint report from public health england and the uk renal registry.infection remains one of the leading causes of mortality in established renal failure patients receiving renal replacement therapy (rrt). since 2007, centres providing rrt in england have been asked to provide additional data on patients with methicillin resistant staphylococcus aureus (mrsa) bacteraemia. since 2011, the option to provide data on methicillin sensitive stapylococcus aureus (mssa) and escherichia coli bacteraemia, as well as clostridium difficile infection has also been available.201324662179
increased hospital length of stay attributable to clostridium difficile infection in patients with four co-morbidities: an analysis of hospital episode statistics in four european countries.hospital-onset clostridium difficile infection (cdi) places a significant burden on health care systems throughout europe, estimated at around €3 billion per annum. this burden is shared between national payers and hospitals that support additional bed days for patients diagnosed with cdi while in hospital or patients re-admitted from a previous hospitalisation. this study was performed to quantify additional hospital stay attributable to cdi in four countries, england, germany, spain, and the n ...201323797490
ribotyping in the detection of clostridium difficile outbreaks in a single university hospital.clostridium difficile infection (cdi) is the most important bacterial cause of hospital-acquired diarrhoea. although reports of deaths associated with cdi have been decreasing since a peak in 2007 in england and northern ireland, it remains a major cause of morbidity and mortality. the health protection agency's clostridium difficile ribotyping network (cdrn) aims to provide information to help optimize the management of cases of cdi. this study assesses the value of ribotyping to detect outbrea ...201323158685
recommendations for surveillance priorities for healthcare-associated infections and criteria for their conduct.surveillance and feedback of results to clinical teams is central to performance improvement in managing healthcare-acquired infections. a major role of the advisory committee on antimicrobial resistance and healthcare-associated infections (arhai) is to advise on surveillance priorities. a sub-committee was set up to systematically review existing uk surveillance schemes. the following three systems were examined in detail: mandatory reporting of methicillin-resistant staphylococcus aureus (mrs ...201222855875
changing epidemiology of clostridium difficile infection following the introduction of a national ribotyping-based surveillance scheme in england.marked increases in clostridium difficile infection (cdi) incidence, driven by epidemic strain spread, is a global phenomenon.201222784871
clinical negligence, litigation and healthcare-associated infections.litigation costs resulting from clinical negligence claims involving healthcare-associated infections are a significant but underappreciated cost to healthcare organizations. in england these claims are handled on behalf of the national health service (nhs) organizations by the nhs litigation authority (nhsla). the total number of claims and the amounts awarded have increased significantly in recent years.201222658237
epidemiological survey of clostridium difficile ribotypes in the north east of england during an 18-month period.during an 18-month period, 1606 stool specimens from laboratory-confirmed cases of clostridium difficile infection in the north east of england were ribotyped using unrestricted polymerase chain reaction. of these, 87.6% grew c. difficile on culture; 70% had one of 10 recognizable ribotypes of which 001, 106 and 027 were the most prevalent. the proportions of ribotypes 002 and 015 declined during the study period, whereas ribotypes 016 and 023 increased. ribotype 005 was significantly more numer ...201222633277
evaluation of the national cleanyourhands campaign to reduce staphylococcus aureus bacteraemia and clostridium difficile infection in hospitals in england and wales by improved hand hygiene: four year, prospective, ecological, interrupted time series study.to evaluate the impact of the cleanyourhands campaign on rates of hospital procurement of alcohol hand rub and soap, report trends in selected healthcare associated infections, and investigate the association between infections and procurement.201222556101
assessment of administrative data for evaluating the shifting acquisition of clostridium difficile infection in england.little is known about the acquisition of clostridium difficile infection (cdi) and whether it represents hospital- or community-acquired infection.201222306443
multiple component patient safety intervention in english hospitals: controlled evaluation of second phase.to independently evaluate the impact of the second phase of the health foundation's safer patients initiative (spi2) on a range of patient safety measures. design a controlled before and after design. five substudies: survey of staff attitudes; review of case notes from high risk (respiratory) patients in medical wards; review of case notes from surgical patients; indirect evaluation of hand hygiene by measuring hospital use of handwashing materials; measurement of outcomes (adverse events, mort ...201121292720
sporicides for clostridium difficile: the devil is in the detail.a taskforce has now been formed with representatives from the department of health's advisory committee on antimicrobial resistance and healthcare associated infection (arhai), the hospital infection society (his), the department of health (england) and the health protection agency. the aims of the arhai/his taskforce on sporicidal disinfectants are: to develop an accepted standard for laboratory testing of disinfectants which claim to have activity against c. difficile spores; to develop a netw ...201121277650
ward-based rather than team-based junior surgical doctors reduce mortality for patients with a fracture of the proximal femur: results from a two-year observational study.we performed a retrospective study of a departmental database to assess the efficacy of a new model of orthopaedic care on the outcome of patients with a fracture of the proximal femur. all 1578 patients admitted to a university teaching hospital with a fracture of the proximal femur between december 2007 and december 2009 were included. the allocation of foundation doctors years 1 and 2 was restructured from individual teams covering several wards to pairs covering individual wards. no alterati ...201121357963
genetic characterisation of clinical isolates of clostridium difficile using an optimised rapd protocol and pcr ribotyping reveals strain diversity between two tertiary referral trusts in the west midlands, uk.epidemiological investigations of clostridium difficile often focus on differences between separate geographical areas. in this investigation, two populations of c. difficile recovered from separate tertiary referral trusts within the west midlands, uk, were characterised using both pcr ribotyping and an optimised rapd protocol. the pcr ribotyping and rapd methodologies identified differences between the two c. difficile populations, both in the prevalence and the diversity of types identified. ...201121511887
increased health burden associated with clostridium difficile diarrhoea in patients with inflammatory bowel disease.background  clostridium difficile (c. difficile) infection in hospitals in developed countries continues to be a major public health hazard despite increased control measures including review of antibiotic policies and hygiene measures. patients with colitis are thought to be particularly vulnerable to c. difficile associated diarrhoea (cdad). identifying the clinical burden among hospitalised patients admitted with inflammatory bowel disease is an essential first step towards identifying and tr ...201121517920
impact of changes in clostridium difficile diagnostic testing on detection of c. difficile infection and all england mandatory surveillance data.following the report of the centre for evidence-based purchasing, which suggested poor performance of clostridium difficile testing kits, revised guidance was issued by the department of health (england) recommending a two-test algorithm. the aim of this study was to survey english national health service (nhs) diagnostic microbiology laboratories using an electronic questionnaire to investigate changes in laboratory procedures in response to the guidance and model the impact these changes had o ...201121764171
diagnostic testing for clostridium difficile: a comprehensive survey of laboratories in england.recent studies have shown poor performance of commonly used toxin enzyme immunoassays (eias) for laboratory testing for clostridium difficile infection (cdi). in 2009-2010, the uk health protection agency and the european society of clinical microbiology and infectious diseases stated that toxin eia testing alone is suboptimal, and recommended a two-step testing protocol (i.e. screening with one method and confirming the results with another method). all acute english national health service tru ...201121724296
impact of guidelines and enhanced antibiotic stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of clostridium difficile infection.objectives to evaluate the impact of an 'intervention' consisting of revised antibiotic guidelines for empirical treatment of common infections and enhanced stewardship on reducing broad-spectrum antibiotic usage and its effect on incidence of clostridium difficile infection (cdi). methods this was a retrospective, quasi-experimental study using interrupted time series (its) over 12 months before and after the intervention. the setting was adult medical and surgical wards in university hospital ...201121676904
co-morbidities as predictors of mortality in clostridium difficile infection and derivation of the arc predictive score.clostridium difficile associated diarrhoea (cdad) has increased significantly in the last 15 years, but predictors of outcome are inadequately understood. this was a cohort study of 2761 patients in north east england between 2002 and 2009, with the end-point of mortality at 30 days. the role of age, gender and co-morbidities was examined by binary logistic regression. rounded odds ratios were used to develop a predictive score. a predictive score based on age, renal disease and cancer (arc scor ...201122047977
Molecular epidemiology of Clostridium difficile strains in children compared with that of strains circulating in adults with Clostridium difficile-associated infection.Molecular analysis of Clostridium difficile (28 isolates) from children (n = 128) in Oxfordshire, United Kingdom, identified eight toxigenic genotypes. Six of these were isolated from 27% of concurrent adult C. difficile-associated infections studied (n = 83). No children carried hypervirulent PCR ribotype 027. Children could participate in the transmission of some adult disease-causing genotypes.201121940476
tackling c difficile with environmental cleaning.chlorine-based cleaning products are often used in acute settings for high-level disinfection of the environment to help control c difficile. however, these products must be used at high concentrations, making them irritant, toxic and corrosive. this means they are inappropriate for the near-patient environment, and can lead to user resistance and non-compliance. more recently, products using peracetic acid and hydrogen peroxide have become available, which are highly effective even under condit ...201121998939
the continuing crisis in antibiotic resistance.the emergence of antibiotic resistance in bacterial pathogens is an inevitable consequence of antibiotic use. despite repeated warnings, negligent antibiotic use and poor infection-control practice have led to the continuing development of extensive resistance problems worldwide. multidrug-resistant pathogens are now characterized by their heterogeneity, increasing virulence, resistance even to reserve agents and spread within and between hospitals and the community. examples are glycopeptide-re ...201021129629
four country healthcare-associated infection prevalence survey: pneumonia and lower respiratory tract infections.in 2006, the hospital infection society was funded by the respective health services in england, wales, northern ireland and the republic of ireland to conduct a prevalence survey of healthcare-associated infection (hcai). here, we report the prevalence of pneumonia and lower respiratory tract infection other than pneumonia (lrtiop) in these four countries. the prevalence of all hcais was 7.59% (5743 out of 75 694). nine hundred (15.7%) of these infections were pneumonia, and 402 (7.0%) were lrt ...201020153552
what has made the difference? 201020381899
reducing clostridium difficile infection in acute care by using an improvement collaborative.in 2006, despite a focus on infection control, salford royal had the fourth highest rate of clostridium difficile infection in north west england.201020659985
antibiotic prophylaxis. mrsa and clostridium difficile are falling. 201020663825
outcomes of patients who develop symptomatic clostridium difficile infection after solid organ transplantation.clostridium difficile-associated diarrhea is the most common cause of hospital-associated diarrhea in the uk. infection can produce a spectrum of manifestations from mild diarrhea to toxic megacolon, colonic perforation, and death. the aim of this study was to evaluate the outcomes of patients who developed symptomatic clostridium difficile infection (cdi) within the first year after solid organ transplantation. between 2004 and 2007, we performed 682 transplantation: 433 from deceased-donor kid ...201020832558
evaluating the link between the management of clinical waste in the national health service (nhs) and the risk of the spread of infections: a case study of three hospitals in england.this study aimed to evaluate waste management practices in three case study nhs trusts in england and the potential risks of the spread of pathogens causing healthcare associated infections (hcais). using a combination of microbiological techniques, interviews and questionnaire surveys, four target microbes were studied, namely: meticillin resistant staphylococcus aureus (mrsa), meticillin sensitive staphylococcus aureus (mssa), clostridium difficile (c. difficile) and vancomycin-resistant enter ...201020833586
epidemiology of community-onset clostridium difficile infection in a community in the south of england.clostridium difficile infection (cdi) has traditionally been considered a hospital acquired infection but there are a rising number of infections in the community. this study estimates the prevalence of community-onset cdi (co-cdi), defined as onset of symptoms in a community setting and outside the hospital, and examines the risk factors for co-cdi in 2-64 year-olds.201020869672
contribution of a government target to controlling clostridium difficile in the nhs in england.the introduction of mandatory surveillance of clostridium difficile infection (cdi) in 2004 showed the scale of the challenge: cases in patients >64 years old reached 55,681 in 2006. the first type 027 outbreaks had been in 2005 and cdi was a headline issue. the prevention and control of cdi requires a tripartite partnership between clinicians, health service managers, and the government/department of health which needs to set standards, ensure that cdi is a priority, set targets and monitor out ...201021182972
seasonal variation of enteric infections and inflammatory bowel disease. 200918942760
medical staff at a london district hospital are not chronic vectors of mrsa or clostridium difficile. 200919362741
accounting for regression-to-the-mean in tests for recent changes in institutional performance: analysis and power.recent changes in individual units are often of interest when monitoring and assessing the performance of healthcare providers. we consider three high profile examples: (a) annual teenage pregnancy rates in english local authorities, (b) quarterly rates of the hospital-acquired infection clostridium difficile in national health service (nhs) trusts and (c) annual mortality rates following heart surgery in new york state hospitals. increasingly, government targets call for continual improvements, ...200919358144
clostridium difficile ribotypes 027 and 106: clinical outcomes and risk factors.the present study investigates risk factors for onset of clostridium difficile-associated diarrhoea, specific ribotype and environmental spore contamination in a district general hospital in south east england. c. difficile isolates were ribotyped from 97 diarrhoeal cases, following detection of c. difficile toxin from faecal specimens by enzyme immunoassay (health protection agency, southampton). the isolates were tested for various antimicrobial susceptibilities by e-test. cases were assessed ...200919386381
novel fit for purpose single use tourniquet: best of both worlds.healthcare associated infections (hai), such as meticillin resistant staphylococcus aureus (mrsa) and clostridium difficile (c. diff) are estimated to cost the nhs pound1 billion and contribute to 5000 deaths/year in the uk. to date the main emphasis to reduce hais has been on hand hygiene. however environmental microbial load and compliance limits the efficacy of hand washing alone. cultures from tourniquets have demonstrated contamination by pathogens including mrsa. consequently, many uk trus ...200919517293
c. difficile infection - a tool for improving practice and reducing rates.clostridium difficile infection (cdi) is a recognized health-care-acquired infection (hai) and as such it is vital that hospitals do more to reduce the rates of infection. patients, especially older people, become particularly susceptible to cdi after treatment with antibiotics. mention of cdi on death certificates is increasing and surveillance, especially when accompanied by feedback to clinicians, has long been established as an effective tool to lower hais. in february 2008, a manchester hos ...200919525909
establishment of an outpatient and home parenteral antimicrobial therapy service at a london teaching hospital: a case series.outpatient and home parenteral antimicrobial therapy (ohpat) is becoming increasingly commonplace in the uk, enabling those patients who would previously have been obliged to remain in hospital for intravenous treatment to be managed as outpatients or in their own homes. the ohpat service at st mary's hospital, london, was established in 2004. this paper describes the types of infection, antimicrobial management and outcomes of patients referred to the service in the 3.5 years since its inceptio ...200919549671
clostridium difficile: how much do hospital staff know about it?the aim of this study was to determine the awareness of clostridium difficile infection amongst healthcare professionals.200919558760
deaths involving clostridium difficile: england and wales, 2008. 200919774833
screens address side room shortage.with side rooms in ever shorter supply across nhs hospitals, the department of health has developed an ingenious portable isolation unit that can be rapidly assembled around the bed of patients suffering infections such as those caused by mrsa and clostridium difficile to help prevent cross-infection and simultaneously help reduce bed blocking. recent trials at the university college hospital in london (uclh), alongside a range of isolation screens, saw the various systems evaluated by clinician ...200919911555
historical and changing epidemiology of healthcare-associated infections.this review compares the historical perspectives on healthcare-associated infections (hcais) with the current changing epidemiological picture as it relates to these infections. evidence in support of these changes is given using trends in mortality for clostridium difficile and meticillin-resistant staphylococcus aureus bacteraemia in england as examples. the impact of current intervention programmes which target these, and other hcais, is also considered and knowledge gaps and options for chan ...200919925942
deaths from norovirus among the elderly, england and wales.the number of deaths in england and wales associated with gastrointestinal pathogens, norovirus in particular, in persons >or=65 years was estimated for 2001-2006. regression analysis was used to model monthly counts of gastrointestinal pathogens in fecal samples from infected patients against monthly counts of deaths from infectious and noninfectious intestinal diseases. data came from the office of national statistics (death registrations from local registrars) and from the health protection a ...200818826817
infection control. a clean bill of health.lat year the health commission detailed findings that contributed to two infection outbreaks at the kent trust. c difficile rates within the trust in the first quarter of this year were 73 per cent lower than in 20007 plans to set up a 200-strong patient council to give feedback to the board are underway. the trust is projecting a financial deficit of pound 3.8m for the current year. staff recruitment has been largely unaffected by the bad publicity and changes within the organisation.200818975411
use of highly discriminatory fingerprinting to analyze clusters of clostridium difficile infection cases due to epidemic ribotype 027 strains.we compared multilocus variable-number tandem-repeat analysis (mlva) and macrorestriction endonuclease analysis using pulsed-field gel electrophoresis (pfge) to determine their utility to identify clusters of clostridium difficile infection (cdi) among 91 isolates of pcr ribotype 027 (nap1, for north american pulsed-field type 1) from nine hospitals (and 10 general practitioners associated with one institution) in england. we also examined whether mortality in cdi cases was associated with speci ...200818216211
deaths involving clostridium difficle: england and wales, 1999 and 2001-06. 200818351026
four country healthcare associated infection prevalence survey 2006: overview of the results.a survey of adult patients was conducted in february 2006 to may 2006 in acute hospitals across england, wales, northern ireland and the republic of ireland to estimate the prevalence of healthcare-associated infections (hcais). a total of 75 694 patients were surveyed; 5743 of these had hcais, giving a prevalence of 7.59% (95% confidence interval: 7.40-7.78). hcai prevalence in england was 8.19%, in wales 6.35%, in northern ireland 5.43% and in the republic of ireland 4.89%. the most common hca ...200818550218
deaths involving mrsa and clostridium difficile by communal establishment: england and wales, 2001-06. 200818595388
deaths involving clostridium difficile; england and wales, 2003-07. 200818810888
descriptive study of selected healthcare-associated infections using national hospital episode statistics data 1996-2006 and comparison with mandatory reporting systems.summary: using hospital episode statistics (hes) data from england for the period 1996-2006, we performed a descriptive study to compare records of clostridium difficile for inpatients aged >or=65 years and for all patients following any of four types of orthopaedic procedures. results showed that infection rates for c. difficile increased whereas rates for orthopaedic surgical site infections (ssis) decreased. both types of infection were more common in older female patients and in patients wit ...200818849092
distribution and antimicrobial susceptibility patterns of clostridium difficile pcr ribotypes in english hospitals, 2007-08.a surveillance study designed to provide a representative sample of the strains of clostridium difficile causing infections in hospitals in england was in operation from april 2007 to the end of march 2008. six hundred and seventy-seven isolates were obtained from 186 hospitals in the nine geographical regions of england as recognised by the health protection agency's regional microbiology network. typing studies revealed that pcr ribotype 027 is now the most common strain isolated from symptoma ...200818926105
has the severity of clostridium difficile infections increased? 200717055114
service improvement. uprooting the causes.root-cause analysis helps organisations to understand and address outcomes without focusing on the symptoms. a pilot led by eastern and coastal kent pct has helped the local health economy to plan to reduce infections. east kent hospitals is building a zero-tolerance culture.200718260604
deaths involving clostridium difficile: england and wales, 2001-2005. 200717373384
improvement targets for c difficile must be valid. 200717413147
beating the bug. 200717539395
hcais: statutory code of practice in england and wales.healthcare-associated infections (hcais) such as meticillin resistant staphylococcus aureus (mrsa) and clostridium difficile (c. dif) are never far from the media headlines. in january 2006 a leaked memo identified the government's concerns that its target of halving mrsa infection rates by april 2008 may not be met (boseley 2007). during 2004-5, 30 people died following two outbreaks of c. dif at stoke mandeville (boseley 2007). in this article the author will focus on and discuss in detail key ...200717598676
hse clears infection death managers. 200717847612
annual incidence of mrsa falls in england, but c difficile continues to rise. 200717991958
infection control. behind closed doors: is kent scandal a one-off. 200718020250
lessons from the maidstone and tunbridge tragedy. 200718073641
infection likely cause of 90 deaths. 200718161446
progress at outbreak trust but doctor hygiene rapped. 200718161470
distribution of clostridium difficile pcr ribotype 027 in british hospitals. 200717868609
lessons from stoke mandeville. 200617077764
there are lessons to be learnt in the aftermath of a scandal. 200616986585
major issues still to be addressed. 200617019902
prospective evaluation of hospital isolation room capacity.risk assessment is used to determine the need for isolation in single rooms. limited availability of isolation rooms and/or operational needs may compromise this process. this article reports the results of a 12-month prospective observational study of every infection control request for isolation in a 1100-bed teaching hospital. in addition, four point-prevalence surveys of the usage of single rooms were carried out. data were collected on the incidence of new clinical meticillin-resistant stap ...200616697305
deaths involving clostridium difficile: england and wales, 1999-2004. 200616759080
number of c difficile cases rises. 200616873836
a staff nurse's perspective of infection control problems.earlier this month astonishing figures causing major concern were released from the department of health (doh) showing the number of cases of clostridium difficile in the over 65s in hospitals in england. this article focuses upon what is already known about infection control and concludes that a greater collaborative approach to infection control is needed, with a prudent use of broad spectrum antibiotics and a greater use of precautionary isolation measures based on patient symptoms, if infect ...200516224329
beating the bugs. 200516259465
subtyping of clostridium difficile pcr ribotype 001 by rep-pcr and pfge.the rep-pcr (repetitive sequence-based pcr using repetitive extragenic palindromic primers) typing method and a modified pfge method were applied to isolates of clostridium difficile pcr ribotype 001 with the aim of comparing their performance as methods of subtyping this organism. of 200 isolates from 60 hospitals tested by rep-pcr, eight subtypes were identified and labelled as rep-pcr subtypes 001-008. the predominant subtype, rep-pcr subtype 003, accounted for 47% of the total. fifty-two of ...200515888462
outbreak of clostridium difficile infection in an english hospital linked to hypertoxin-producing strains in canada and the us. 200516783109
uk launches inquiry into clostridium difficile outbreak. 200516027424
impact of mandatory clostridium difficile surveillance on diagnostic services. 200415501344
epidemiology and cost of nosocomial gastroenteritis, avon, england, 2002-2003.healthcare-associated outbreaks of gastroenteritis are an increasingly recognized problem, but detailed knowledge of the epidemiology of these events is lacking. we actively monitored three hospital systems in england for outbreaks of gastroenteritis in 2002 to 2003. a total of 2,154 patients (2.21 cases/1,000-hospital-days) and 1,360 healthcare staff (0.47 cases/1,000-hospital-days) were affected in 227 unit outbreaks (1.33 outbreaks/unit-year). norovirus, detected in 63% of outbreaks, was the ...200415504271
national clostridium difficile standards group: report to the department of health. 200415129935
the prevention of clostridium difficile associated diarrhoea in hospital.the number of health care-associated infections has increased over the years and generated a lot of interest and concern. the attention tends to be focused on methicillin-resistant staphylococcus aureus (mrsa), but the less publicised clostridium difficile is a growing problem. it increases length of hospital stay, causes significant morbidity in patients, affects nurses' workloads, adds to the cost of cleaning, laundry and disposables, and can lead to ward closures. all nhs trusts in england ar ...200415318695
clostridium difficile: a questionnaire survey of laboratory practice in england, wales, and northern ireland.since january 2004, the incidence of clostridium difficile associated disease (cdad) has been monitored by a systematic, national, laboratory surveillance system. this system incorporates the recommendations of a body of experts, the national clostridium difficile standards group, which was convened in 2002 to advise the department of health (doh). the recommendations of the group were informed by a questionnaire survey of current practice, and the results of that survey have been used to assess ...200415779799
evidence to support the existence of subgroups within the uk epidemic clostridium difficile strain (pcr ribotype 1).we used three different dna fingerprinting techniques and clindamycin susceptibility testing to confirm that clostridium difficile pcr ribotype i isolates can be divided into two subclones. this observation may permit a better understanding of the epidemiology and pathogenicity of c. difficile infection.200312767851
impact of changes in antibiotic policy on clostridium difficile-associated diarrhoea (cdad) over a five-year period in a district general hospital.the impact of changes in antibiotic policy on clostridium difficile-associated diarrhoea (cdad), over a five-year period between 1995 and 2000, were studied in the preston acute hospitals trust. in 1996 the policy was changed in the preston acute hospitals trust from cefotaxime to ceftriaxone for initial treatment of severe sepsis or pneumonia in medical patients. over the next nine months the average number of patients with c. difficile toxin-positive stools per quarter increased from 16 to 39. ...200312818582
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