Table 3.
CDI bundle effectiveness
| First author | Pre-intervention CDI rate (cases/1,000 PD) |
Post-intervention CDI rate (cases/1,000 PD) |
CDI rate reduction (%) |
|---|---|---|---|
| Eight interventions in bundlea | |||
| Abbett40 | 1.1 (95% CI: 1.00–1.21) | 0.66 (95% CI: 0.60–0.72) | 40%; RR: 0.60 (95% CI: 0.52 – 0.68), p<0.001 |
| Oleastro28 | 0.823b | 0.119 | 85.5% |
| Seven interventions in bundle | |||
| Brakovich50 | 5.652 | 3.151 | 44.2%, p<0.001 |
| Cheng34 | Increase 17.0% per quarter | Decrease 6.1% per quarter | |
| Marufu26 | 5.2 /1,000 admissions | 1.1 /1,000 admissions | 78.7% |
| Mermel44 | 12.2/1,000 dischargesb | 3.6/1,000 discharges | 70.5% |
| Muto38 | 10.4/1,000 dischargesb | 3.0/1,000 discharges | 71%; OR: 0.286 (95% CI: 0.185, 0.435), p<0.001 |
| Weiss39 | 37.28 /1000 admissionsb | 14.48 /1000 admissions | 61%, OR 0.379 (95% CI: 0.331–0.435), p<0.001 |
| Whitaker42 | 1.33 | 0.45 | 66% |
| White33 | 170 cases/month | 2–11 cases/month | 80% |
| Zafar45 | 155/year | 65/year | 60%, p<0.05 |
| Six interventions in bundle | |||
| Bishop49 | 4.13/month (SD: 2.64) | 1.93/month (SD: 1.56) | 53%, p=0.03 |
| Hanna41 | 60% attack rateb | 17% attack rate | 72%, p<0.05 |
| Struelens32 | 0.178b | 0.034 | 77.3% |
| Five interventions in bundle | |||
| Gulihar25 | 7.1% patients develop CDI | 1.5% patients develop CDI | 79%, p <0.001 |
| Lai47 | 22.5/1,000 dischargesb | 13.2/1,000 discharges | 41.3% |
| Power29 | 2.60 (95% CI: 2.11–3.17) intervention; 1.15 (95% CI: 1.03–1.29) control | 0.69 (95%CI: 0.50–0.91) Intervention; 0.51 (95% CI: 0.44–0.60) control | 73.46% intervention; 55.65% control |
| Valiquette37 | 2.03b | 0.82 | 60%, p=0.007 |
| Wong-McClure43 | 2.96b | 2.12 | 28.4%, p=0.001 |
| You36 | 4.70 | 1.53 | 67%; OR: 0.36 (95% CI: 0.13 – 0.85), p=0.012 |
| Four interventions in bundle | |||
| Apisarnthanarak48 | 5.8 MICU; 8.0 BMTb | 2.1 MICU; 4.2 BMT | MICU 63.8%, p=0.05; BMT 47.5%, p=0.04 |
| Mattner27 | 1.08b | Data in bar graph | 8 wards significantly reduced CDI |
| Three interventions in bundle | |||
| Price30 | 1.30 | 0.69 | 46.9%, p=0.03 |
| Salgado46 | 5.52b | 1.24 | 77.5% |
| Stone31 | 33.5 /1,000 admissions | 19.4 /1,000 admissions | 42%, p<0.05 |
| Suzuki35 | 0.471b | 0.108 | 77%, p<0.001 |
a
Education is considered one intervention, whether it includes staff and/or patient components;
b
Pre-intervention data collected during CDI outbreak
BMT: Bone marrow transplant, CDI: Clostridium difficile infection, CI: confidence interval, MICU: Medical intensive care unit, OR: Odds ratio, PD: patient days, SD: Standard deviation, RR: Relative risk