Association of Visitor Contact Precautions With Estimated Hospital-Onset Clostridioides difficile Infection Rates in Acute Care Hospitals

This simulation study estimates the association between visitor contact precautions and the rate of hospital-onset C difficile infection in an acute care hospital. Question Is there an association between visitor contact precautions and hospital-onset Clostridioides difficile infection in acute care hospitals? Findings In this simulation study of a generic acute care adult hospital, in all experiments, use of visitor contact precautions was associated with a decrease of 1% or less in the rate of hospital-onset C difficile infection; small improvements in hand hygiene and environmental cleaning were associated with larger decreases in hospital-onset C difficile infection. Meaning In this study, visitor contact precautions were associated with minimal reductions in hospital-onset C difficile infections, suggesting that hospitals may achieve a larger reduction through other interventions. Importance Visitor contact precautions (VCPs) are commonly used to reduce the transmission of Clostridioides difficile at health care institutions. Implementing VCPs requires considerable personnel and personal protective equipment resources. However, it is unknown whether VCPs are associated with reduced hospital-onset C difficile infection (HO-CDI) rates. Objective To estimate the association between VCPs and HO-CDI rates using simulation modeling. Design, Setting, and Participants This simulation study, conducted between July 27, 2020, and August 11, 2020, used an established agent-based simulation model of C difficile transmission in a 200-bed acute care adult hospital to estimate the association between VCPs and HO-CDI while varying assumptions about factors such as patient susceptibility, behavior, and C difficile transmission. The model simulated hospital activity for 1 year among a homogeneous, simulated adult population. Interventions No VCP use vs ideal use of VCPs under different hospital configurations. Main Outcomes and Measures The rate of HO-CDI per 10 000 patient-days according to the Centers for Disease Control and Prevention's definition of HO-CDI. Results With use of the simulation model, the baseline rate of HO-CDI was 7.94 10 000 patient-days (95% CI, 7.91-7.98 per 10 000 patient-days) with no VCP use compared with 7.97 per 10 000 patient-days (95% CI, 7.93-8.01 per 10 000 patient-days) with ideal VCP use. Visitor contact precautions were not associated with a reduction of more than 1% in HO-CDI rates in any of the tested scenarios and hospital settings. Independently increasing the hand-hygiene compliance of the average health care worker and environmental cleaning compliance by no more than 2% each was associated with greater HO-CDI reduction compared with all other scenarios, including VCPs. Conclusions and Relevance In this simulation study, the association between VCPs and HO-CDI was minimal, but improvements in health care worker hand hygiene and environmental cleaning were associated with greater reductions in estimated HO-CDI. Hospitals may achieve a higher rate of reduction for HO-CDI by focusing on making small improvements in compliance with interventions other than VCP.