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Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea.

Abstract

BACKGROUND

The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking.

AIM

To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards.

METHODS

A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 hours were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea-onset >48 hours after admission). Data on HOD aetiology and management were collected prospectively.

FINDINGS

Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% CI 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. 9/75 tested patients were Clostridium difficile toxin positive (4%). 80 (35%) patients had a documented medical assessment of the diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested versus 38% not tested, p<0.001). 144 (63%) patients were not isolated following diarrhoea onset.

CONCLUSION

HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients have multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated.

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  • Authors+Show Affiliations

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    Trust grade microbiologist, Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK. Electronic address: damian.mawer@nhs.net.

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    Specialty registrar, Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.

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    Specialty registrar, Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.

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    Research nurse, Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.

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    Specialty registrar, Department of Microbiology, Leeds Teaching Hospitals NHS Trust, Leeds, LS9 7TF, UK.

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    Specialty registrar, Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

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    Specialty registrar, Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

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    NIHR Academic Clinical Fellow in Infectious Diseases, Royal Papworth Hospital NHS Foundation Trust, Papworth Everard, Cambridge, CB23 3RE, UK.

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    Specialty registrar, Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

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    Specialty registrar, Department of Infectious Diseases, Cambridge University Hospitals NHS Foundation Trust, Cambridge, CB2 0QQ, UK.

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    Lead nurse for Infection Prevention, Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK.

    ,

    Senior Infection Prevention nurse, Department of Infection Prevention, Royal Gwent Hospital, Newport, NP20 2UB, UK.

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    Consultant microbiologist, Department of Microbiology, Barnsley Hospital NHS Foundation Trust, Barnsley, S75 2EP, UK.

    ,

    Director of Infection Prevention and Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.

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    Specialty registrar, Department of Medicine, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.

    ,

    Lead infection control nurse, Department of Infection Prevention & Control, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, BD9 6RJ, UK.

    ,

    Consultant microbiologist, Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK.

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    Foundation Year 1 doctor, Department of Microbiology, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK.

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    Foundation year 2 doctor, East Lancashire Hospitals NHS Trust, Blackburn, BB2 3HH, UK.

    ,

    Specialty registrar, Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

    ,

    Consultant microbiologist, Department of Microbiology, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

    ,

    Infection control nurse, Department of Infection Prevention and Control, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

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    Acting lead infection prevention nurse, Department of Infection Prevention and Control, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

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    Vascular access nurse, Department of Infection Prevention and Control, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

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    Infection surveillance coordinator, Department of Infection Prevention and Control, Hampshire Hospitals NHS Foundation Trust, Winchester, SO22 5DG, UK.

    ,

    Specialty registrar, Department of Microbiology, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK.

    ,

    Lead Infection Control nurse, Department of Infection Prevention & Control, Harrogate and District NHS Foundation Trust, Harrogate, HG2 7SX, UK.

    ,

    Specialty registrar, Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK.

    ,

    Specialty registrar, Department of Infectious Diseases, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK.

    ,

    Lead Nurse, Department of Infection Prevention & Control, Hull & East Hospitals NHS Trust, Hull, HU3 2JZ, UK.

    ,

    Infection prevention and control nurse, Department of Infection Prevention & Control, Hull and East Yorkshire Hospitals NHS Trust, Hull, HU3 2JZ, UK.

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    Consultant microbiologist, Department of Microbiology, Mid Yorkshire Hospitals NHS Trust, Wakefield, WF1 4DG, UK.

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    Core medical trainee, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK.

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    Foundation Year 2 doctor, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK.

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    Foundation Year 1 doctor, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK.

    ,

    Consultant microbiologist, Department of Microbiology, Inverclyde Royal Hospital, Greenock, PA16 0XN, UK.

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    Specialty registrar, Department of Microbiology, Royal Infirmary of Edinburgh, Edinburgh, EH16 4SA, UK.

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    Matron, Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.

    ,

    Infection control nurse, Department of Infection Prevention & Control, Nottingham University Hospitals NHS Trust, Nottingham, NG7 2UH, UK.

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    Consultant in infectious diseases & microbiology, Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK.

    ,

    Clinical research fellow, Nuffield Department of Medicine, University of Oxford, OX3 7FZ, UK.

    ,

    Specialty registrar, Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK.

    ,

    Specialty registrar, Department of Infectious Diseases, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK.

    ,

    Specialty registrar, Department of Medicine, Oxford University Hospitals NHS Trust, Oxford, OX3 9DU, UK.

    ,

    Specialty registrar, Department of Microbiology, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF.

    ,

    Infection control nurse, Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF.

    ,

    Infection control nurse, Department of Infection Prevention & Control, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, S10 2JF.

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    Consultant in infectious diseases, Department of Medicine, Friarage Hospital, South Tees Hospital NHS Foundation Trust, Northallerton, DL6 1JG, UK.

    ,

    Lead infection control nurse, Department of Infection Prevention & Control, James Cook University Hospital, South Tees Hospital NHS Foundation Trust, Middlesborough, TS4 3BW. UK.

    ,

    Consultant microbiologist, Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

    ,

    Infection control nurse, Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

    ,

    Specialty registrar, Department of Microbiology, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

    ,

    Senior infection control nurse, Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

    ,

    Infection control nurse, Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

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    Infection prevention nurse manager, Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

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    Head of nursing, Corporate Support Services, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

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    Infection prevention nurse manager, Department of Infection Prevention & Control, The Royal Wolverhampton NHS Trust, Wolverhampton, WV10 0QP, UK.

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    Director of Infection Prevention and Control, Department of Microbiology, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK.

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    Lead infection control nurse, Department of Infection Prevention & Control, Torbay and South Devon Healthcare NHS Foundation Trust, Torquay, TQ2 7AA, UK.

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    Infection prevention and control lead, Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

    ,

    Senior infection prevention and control nurse, Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

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    Lead antimicrobial pharmacist, Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

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    Antimicrobial pharmacist, Pharmacy Department, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

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    Infection prevention and control lead, Department of Infection Prevention & Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

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    Infection prevention and control nurse, Department of Infection Prevention and Control, Ulster Hospital, South Eastern Health and Social Care Trust, Belfast, BT16 1RH, UK.

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    Clinical scientist, Department of Microbiology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK.

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    Clinical scientist, Department of Virology and Molecular Pathology, University Hospital Coventry, University Hospitals of Coventry and Warwickshire, Warwick, CV2 2DX, UK.

    ,

    Specialty registrar, Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.

    ,

    Specialty registrar, Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.

    ,

    Specialty registrar, Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.

    ,

    Specialty registrar, Department of Microbiology, University Hospitals of Leicester NHS Trust, Leicester, LE1 5WW, UK.

    ,

    Specialty registrar, Department of Microbiology, York Teaching Hospital NHS Foundation Trust, York, YO31 8HE, UK.

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    Senior lecturer, Stroke physician and consultant physician for older people, Royal Free Campus, University College Medical School, London, NW3 2QG, UK.

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    Specialty registrar, Department of Microbiology, Royal Free Hospital, University College London Hospitals NHS Foundation Trust, London, NW3 2QG, UK.

    ,

    Consultant microbiologist, Department of Microbiology, Royal Free Hospital, Royal Free London NHS Foundation Trust, London, NW3 2QG, UK.

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    Consultant microbiologist, Department of Microbiology, Antrim Area Hospital, Northern Health and Social Care Trust, Bush Road, Antrim, BT41 2RL, UK.

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    Professor of biostatistics, Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9JT, UK.

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    Professor of medical microbiology, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK.

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    Associate clinical professor in microbiology, Leeds Institute of Medical Research, University of Leeds, Leeds, LS2 9JT, UK.

    Associate clinical professor in microbiology, Leeds Institute of Biomedical and Clinical Sciences, University of Leeds, Leeds, LS2 9JT, UK.

    Source

    Pub Type(s)

    Journal Article

    Language

    eng

    PubMed ID

    31077777

    Citation

    Mawer, Damian, et al. "Cross-sectional Study of the Prevalence, Causes and Management of Hospital-onset Diarrhoea." The Journal of Hospital Infection, 2019.
    Mawer D, Byrne F, Drake S, et al. Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. J Hosp Infect. 2019.
    Mawer, D., Byrne, F., Drake, S., Brown, C., Prescott, A., Warne, B., ... Sandoe, J. A. (2019). Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. The Journal of Hospital Infection, doi:10.1016/j.jhin.2019.05.001.
    Mawer D, et al. Cross-sectional Study of the Prevalence, Causes and Management of Hospital-onset Diarrhoea. J Hosp Infect. 2019 May 8; PubMed PMID: 31077777.
    * Article titles in AMA citation format should be in sentence-case
    TY - JOUR T1 - Cross-sectional study of the prevalence, causes and management of hospital-onset diarrhoea. AU - Mawer,Damian, AU - Byrne,Fiona, AU - Drake,Sarah, AU - Brown,Claire, AU - Prescott,Alison, AU - Warne,Ben, AU - Bousfield,Rachel, AU - Skittrall,Jordan P, AU - Ramsay,Isobel, AU - Somasunderam,Donald, AU - Bevan,Moira, AU - Coslett,Julie, AU - Rao,Jyothi, AU - Stanley,Philip, AU - Kennedy,Adrian, AU - Dobson,Rosemarie, AU - Long,Sandra, AU - Obisanya,Tobi, AU - Esmailji,Taher, AU - Petridou,Christina, AU - Saeed,Kordo, AU - Brechany,Kelly, AU - Davis-Blue,Karen, AU - O'Horan,Helen, AU - Wake,Bruce, AU - Martin,Jessica, AU - Featherstone,Jennifer, AU - Hall,Charlotte, AU - Allen,Joanna, AU - Johnson,Greta, AU - Hornigold,Cheryll, AU - Amir,Nurul, AU - Henderson,Kathleen, AU - McClements,Catriona, AU - Liew,Ignatius, AU - Deshpande,Ashutosh, AU - Vink,Elen, AU - Trigg,Debbie, AU - Guilfoyle,Jane, AU - Scarborough,Matthew, AU - Scarborough,Claire, AU - Wong,Th Nicholas, AU - Walker,Timothy, AU - Fawcett,Nicola, AU - Morris,Gayti, AU - Tomlin,Kim, AU - Grix,Caroline, AU - O'Cofaigh,Emma, AU - McCaffrey,David, AU - Cooper,Michael, AU - Corbett,Kim, AU - French,Kathryn, AU - Harper,Susan, AU - Hayward,Claire, AU - Reid,Matthew, AU - Whatley,Vanessa, AU - Winfield,Jodie, AU - Hoque,Selina, AU - Kelly,Lynn, AU - King,Isobel, AU - Bradley,Amy, AU - McCullagh,Bernie, AU - Hibberd,Carleen, AU - Merron,Monica, AU - McCabe,Caroline, AU - Horridge,Samantha, AU - Taylor,Johnathan, AU - Koo,Sharon, AU - Elsanousi,Fadwa, AU - Saunders,Rosalind, AU - Lim,Felicia, AU - Bond,Amy, AU - Stone,Sheldon, AU - Milligan,Iain D, AU - Mack,Damien Jf, AU - Nagar,Aaron, AU - West,Robert M, AU - Wilcox,Mark H, AU - Kirby,Andrew, AU - Sandoe,Jonathan At, Y1 - 2019/05/08/ PY - 2019/04/06/received PY - 2019/05/01/accepted PY - 2019/5/12/entrez PY - 2019/5/12/pubmed PY - 2019/5/12/medline KW - Clostridium difficile KW - Diarrhoea KW - hospital acquired KW - hospital onset KW - nosocomial JF - The Journal of hospital infection JO - J. Hosp. Infect. N2 - BACKGROUND: The National Health Service in England advises hospitals collect data on hospital-onset diarrhoea (HOD). Contemporaneous data on HOD are lacking. AIM: To investigate prevalence, aetiology and management of HOD on medical, surgical and elderly-care wards. METHODS: A cross-sectional study in a volunteer sample of UK hospitals, which collected data on one winter and one summer day in 2016. Patients admitted ≥72 hours were screened for HOD (definition: ≥2 episodes of Bristol Stool Type 5-7 the day before the study, with diarrhoea-onset >48 hours after admission). Data on HOD aetiology and management were collected prospectively. FINDINGS: Data were collected on 141 wards in 32 hospitals (16 acute, 16 teaching). Point-prevalence of HOD was 4.5% (230/5142 patients; 95% CI 3.9-5.0%). Teaching hospital HOD prevalence (5.9%, 95% CI 5.1-6.9%) was twice that of acute hospitals (2.8%, 95% CI 2.1-3.5%; odds ratio 2.2, 95% CI 1.7-3.0). At least one potential cause was identified in 222/230 patients (97%): 107 (47%) had a relevant underlying condition, 125 (54%) were taking antimicrobials, and 195 (85%) other medication known to cause diarrhoea. 9/75 tested patients were Clostridium difficile toxin positive (4%). 80 (35%) patients had a documented medical assessment of the diarrhoea. Documentation of HOD in medical notes correlated with testing for C. difficile (78% of those tested versus 38% not tested, p<0.001). 144 (63%) patients were not isolated following diarrhoea onset. CONCLUSION: HOD is a prevalent symptom affecting thousands of patients across the UK health system each day. Most patients have multiple potential causes of HOD, mainly iatrogenic, but only a third had medical assessment. Most were not tested for C. difficile and were not isolated. SN - 1532-2939 UR - https://www.unboundmedicine.com/medline/citation/31077777/Cross-sectional_study_of_the_prevalence,_causes_and_management_of_hospital-onset_diarrhoea L2 - https://linkinghub.elsevier.com/retrieve/pii/S0195-6701(19)30192-6 DB - PRIME DP - Unbound Medicine ER -