The Effects of COVID-19 Precautions on the Rates of Clostridium difficile Infection

Introduction: Clostridium difficile infection (CDI) is one of the most common hospital-acquired infections and has been increasing in frequency and severity worldwide. Not only does CDI cause significant patient morbidity and mortality, but it also causes an increase in hospital length of stay and healthcare costs. The primary objective of this study is to identify if increased use of personal protective equipment (PPE) and proper hand hygiene decreased the rates of CDI amidst the Covid-19 pandemic. The secondary objective is to determine if patients infected with Covid-19 were at increased risk of contracting Clostridium difficile (CD). Methods: Our study is a retrospective, single-center analysis identifying the rates of CDI in a hospital setting six months (August 2019-January 2020) before the pandemic and six months (February 2020-July 2020) from the first encountered Covid-19 positive patient at our institution. RStudio software was utilized to query all patients in which CD enzyme immunoassay analysis (EIA) was ordered. Chart review was performed to identify test result outcomes along with Covid-19 status history. Outcomes of interest included rates of CDI between the two specified time periods and rates of CDI in patients that had tested positive for Covid-19. Significance of outcomes was analyzed using Chi-square tests. Results: Patient data is summarized in Table. A total of 776 CD EIA labs were ordered during the pre-pandemic (n=372) and pandemic (n=404) time period of interest For CD, 46 patients tested positive pre-pandemic and 51 patients tested positive during the pandemic. There was no statistical significance in the rate of CDI (P=0.91). Subgroup analysis showed that 35 patients tested positive for Covid-19 of which 6 patients also tested positive for CDI. There was no statistical significance between the rate of CDI and Covid-19 infection (P=0.42). Conclusion: Our retrospective study did not demonstrate a significance that the use of PPE during the Covid-19 pandemic affected overall rates of CDI at our institution. We think that this may demonstrate the true potency of a CD. Our theory is that despite proper PPE, hand hygiene with alcohol-based solutions was commonly used during the pandemic rather than the recommended soap and water required for proper CD hygiene. In future analysis, we hope to increase the power of our study by adjusting our time interval to mirror peak Covid-19 infection rates at our institution.Table 1.: Rates of Clostridium difficile infection and associative Covid-19 positivity.