Screening for asymptomatic C difficile to reduce disease incidence
Research type
Research Study
Full title
Pilot study to determine the feasibility of screening of hospital patients on admission for asymptomatic C difficile in order to act to reduce subsequent disease incidence
IRAS ID
240242
Contact name
Brendan Healy
Contact email
Sponsor organisation
Public Health Wales
Duration of Study in the UK
0 years, 6 months, 31 days
Research summary
Despite a downward trend in C difficile infection disease incidence remains high within the Welsh health care setting with significant morbidity and mortality amongst affected patients. Previous research has suggested that early identification of asymptomatic carriage may support measures to reduce incidence. This project proposes to assess the feasibility of incorporating a structured response to improve the management of C difficile infection in a sample of Welsh acute hospitals by screening patients for asymptomatic carriage and where and when it is identified putting in place a mechanism to alert staff to carriage status and enhanced scrutiny of antibiotic prescribing. The key outcome measures will be up take of the screening and subsequent adoption of the intervention.
We propose to carry out this work in medical admission wards in two Welsh health boards. All asymptomatic patients aged over 18 admitted to medical admission wards in the study hospitals will be asked to provide a faecal sample or rectal swab. Where verbal consent is obtained from patients the samples will be tested by the existing NHS diagnostic microbiology service for the presence of C difficile. Results will be sent back to the clinical team caring for the patient and entered in the patient's notes. Where carriage is identified the clinical teams will be alerted to support infection prevention. In addition, due to the compelling research evidence implicating broad spectrum antibiotic use (particularly cephalosporin and fluoroquinolone treatments) as risk factors for disease any antibiotics prescribed for these patients will be subject to additional expert scrutiny with the aim of minimising risk to patients of C difficle infection and maximising the targeted benefits of appropriate prescribing. The study will also allow an estimate of C difficle carriage rates.
REC name
Wales REC 5
REC reference
18/WA/0371
Date of REC Opinion
12 Feb 2019
REC opinion
Further Information Favourable Opinion