Infection Control & Hospital Epidemiology (2018), 39, 1149–1153 doi:10.1017/ice.2018.209
SHEA White Paper
SHEA neonatal intensive care unit (NICU) white paper series: Practical approaches to Clostridioides difficile prevention
Thomas J. Sandora MD, MPH1, Kristina K. Bryant MD2, Joseph B. Cantey MD3, Alexis M. Elward MD, MPH4, Deborah S. Yokoe MD, MPH5 and Allison H. Bartlett MD, MS6 1Boston Children’s Hospital, Boston, Massachusetts, 2University of Louisville, Louisville, Kentucky, 3The University of Texas Health Science Center, San Antonio,
Texas, 4Washington University School of Medicine, St Louis, Missouri, 5University of California, San Francisco, California and 6University of Chicago and Comer Children’s Hospital, Chicago, Illinois
(Received 17 July 2018; accepted 21 July 2018; electronically published August 30, 2018) Introduction
This white paper provides clinicians with practical advice related to Clostridioides difficile in neonatal intensive care unit (NICU) patients. Clostridioides difficile infection (CDI) is among the most prevalent and important healthcare-associated infections (HAIs) affecting children,1,2 but reports of CDI in infants<12 months of age are rare, perhaps because of a relative resistance to the effects of C. difficile toxins or other protective factors in the intestinal environment of infants.3 Additionally, high colonization rates in infants (~35%) make interpretation of positive C. difficile tests in NICU patients uniquely challenging. For these reasons, the authors do not recommend routine testing for C. difficile in NICU patients; NICU patients should be evaluated for other more common causes of diarrhea. Few data exist in the published literature about pre- venting C. difficile in the NICU in endemic settings.
Intended use
The SHEA intends this document to serve as a companion to the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices Advisory Committee (HICPAC) “Clostridioides difficile in Neonatal Intensive Care Unit Patients: A Systematic Review,” to provide practical, expert opinion-based answers to frequently asked questions on C. difficile detection and prevention in the NICU. These questions are not adequately addressed in the published literature to meet Grading of Recommendations Assessment, Development and Evaluation (GRADE) standards4 and therefore were not included in the HICPAC systematic review. No guideline, expert guidance, or white paper can anticipate
all situations, and this document is not meant to be a substitute for individual judgment by qualified professionals.
Author for correspondence: Thomas J. Sandora, MD, MPH, Boston Children’s
Hospital, 300 Longwood Avenue, Boston, MA 02115. E-mail:
thomas.sandora@childrens.
harvard.edu
Cite this article: Sandora TJ, et al. (2018). SHEA neonatal intensive care unit (NICU)
white paper series: Practical approaches to Clostridioides difficile prevention. Infection Control & Hospital Epidemiology 2018, 39, 1149–1153. doi: 10.1017/ice.2018.209
© 2018 by The Society for Healthcare Epidemiology of America. All rights reserved. Methods
This document was developed by a writing panel of pediatric and pathogen-specific experts who collaborated with members of the HICPAC systematic review writing panel and the SHEA Pediatric Leadership Council to identify questions that should be addres- sed. Unlike the SHEA expert guidance format, this document is not based on a systematic literature search; instead, for the selected topic, the authors provide practical approaches in question-and-answer format based on expert opinion and con- sensus within the context of the HICPAC systematic review. The SHEA Guidelines Committee and the SHEA Publications Committee reviewed this document, and the SHEA Board of Trustees endorsed it. The paper has also been endorsed by the American Hospital Association (AHA), The Joint Commission, The Pediatric Infectious Diseases Society (PIDS), the Association for Professionals in Infection Control and Epidemiology (APIC), the Infectious Diseases Society of America (IDSA), and the National Association of Neonatal Nurses (NANN).
Authors
The authors are current and past members of the SHEA Guidelines Committee and the SHEA Pediatric Leadership Council, who serve as volunteers. All authors are involved at their respective institutions in the development of policies pertaining to pediatric infection prevention, either directly or in an advisory role. The NICU Advisory Panel, which provided oversight and review
of the paper, is composed of representatives from the Society for Healthcare Epidemiology of America (SHEA), the American Academy of Pediatrics (AAP), the Association for Professionals in Infection Control and Epidemiology (APIC), the InfectiousDiseases Society of America (IDSA), the National Association of Neonatal Nurses (NANN), the Pediatric Infectious Diseases Society (PIDS), and The Joint Commission.
Practical approaches: questions and answers
Question: When should clinicians test a NICU patient for CDI? Answer:
∙ The authors advise against routine testing for CDI in NICU patients because of the high prevalence of asymptomatic
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