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How do hospital professionals involved in a randomised controlled trial perceive the value of genotyping vs. PCR-ribotyping for control of hospital acquired C. difficile infections?

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Szczepura, Ala, Manzoor, Susan, Hardy, K. (Katherine), Stallard, Nigel, Parsons, Helen, Gossain, Savita and Hawkey, P. M. (Peter M.) (2014) How do hospital professionals involved in a randomised controlled trial perceive the value of genotyping vs. PCR-ribotyping for control of hospital acquired C. difficile infections? BMC Infectious Diseases, Volume 14 (Number 1). Article number 154. doi:10.1186/1471-2334-14-154

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Official URL: http://dx.doi.org/10.1186/1471-2334-14-154

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Abstract

Background:
Despite scientific advances in typing of C. difficile strains very little is known about how hospital staff use typing results during periods of increased incidence (PIIs). This qualitative study, undertaken alongside a randomised controlled trial (RCT), explored this issue. The trial compared ribotyping versus more rapid genotyping (MLVA or multilocus variable repeat analysis) and found no significant difference in post 48 hour cases (C difficile transmissions).

Methods:
In-depth qualitative interviews with senior staff in 11/16 hospital trusts in the trial (5 MLVA and 6 Ribotyping). Semi-structured interviews were conducted at end of the trial period. Transcripts were content analysed using framework analysis supported by NVivo-8 software. Common sub-themes were extracted by two researchers independently. These were compared and organised into over-arching categories or ‘super-ordinate themes’.

Results:
The trial recorded that 45% of typing tests had some impact on infection control (IC) activities. Interviews indicated that tests had little impact on initial IC decisions. These were driven by hospital protocols and automatically triggered when a PII was identified. To influence decision-making, a laboratory turnaround time < 3 days (ideally 24 hours) was suggested; MLVA turnaround time was 5.3 days. Typing results were predominantly used to modify initiated IC activities such as ward cleaning, audits of practice or staff training; major decisions (e.g. ward closure) were unaffected. Organisational factors could limit utilisation of MLVA results. Results were twice as likely to be reported as ‘aiding management’ (indirect benefit) than impacting on IC activities (direct effect). Some interviewees considered test results provided reassurance about earlier IC decisions; others identified secondary benefits on organisational culture. An underlying benefit of improved discrimination provided by MLVA typing was the ability to explore epidemiology associated with CDI cases in a hospital more thoroughly.

Conclusions:
Ribotyping and MLVA are both valued by users. MLVA had little additional direct impact on initial infection control decisions. This would require reduced turnaround time. The major impact is adjustments to earlier IC measures and retrospective reassurance. For this, turnaround time is less important than discriminatory power. The potential remains for wider use of genotyping to examine transmission routes.

Item Type: Journal Article
Subjects: R Medicine > RA Public aspects of medicine
Divisions: Faculty of Medicine > Warwick Medical School > Health Sciences
Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH): Clostridium difficile, Nosocomial infections, Diagnosis, Laboratory
Journal or Publication Title: BMC Infectious Diseases
Publisher: BioMed Central Ltd.
ISSN: 1471-2334
Official Date: 21 March 2014
Dates:
DateEvent
21 March 2014Published
27 January 2014Accepted
5 December 2012Submitted
Volume: Volume 14
Number: Number 1
Article Number: Article number 154
DOI: 10.1186/1471-2334-14-154
Status: Peer Reviewed
Publication Status: Published
Access rights to Published version: Open Access
Funder: Great Britain. Department of Health (DoH)
Grant number: 0190014 (DoH)

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