Clostridioides difficile transmission: a compartmental model accounting for environmental spore persistence

Objective To set up a compartmental model, including environmental spore levels, for C. difficile transmission dynamics in a hospital and determine the effect of preventive interventions on infection and colonization rates. Design Intervention study within a compartmental mathematical modeling framework. Setting A simulated Swedish 500-bed secondary care hospital. Interventions modeled Antibiotic stewardship, improved isolation of infected patients, improved general cleaning and disinfection. Results Antibiotic stewardship had the largest effect on infections, with a 30.6% decrease in infection prevalence. Improved general cleaning and disinfection had the largest effect on colonization (–22.5%) and environmental spore levels (–39.7%). Improved isolation of infected patients had modest effects in comparison. Conclusions Modeling that includes the dynamics of environmental spores can aid our understanding of C. difficile transmission within hospitals. Antibiotic stewardship and improved general cleaning and disinfection showed the largest potential for prevention in our modeled setting.