Electronic surveillance system shortens time-to-action and improves adherence to the isolation bundle for patients with Clostridioides difficile infection: an interrupted time series at a French university hospital.

BACKGROUND

Electronic surveillance systems may assist infection prevention and control (IPC) teams in detecting and monitoring patients infected with pathogens such as Clostridioides difficile. We aimed to estimate the impact of an electronic surveillance system on the audit rate conducted by the IPC team, response timeliness, and compliance with the C. difficile isolation bundle.

METHODS

A quasi-experimental before-after study was conducted using an interrupted time series analysis from 2018 to 2025 at the University Hospital of Nancy (France). The electronic surveillance system ZINC™ was implemented in October 2022. The results of audits conducted by the IPC team to investigate isolation measures for all inpatients with positive C. difficile sample tests were aggregated on a monthly basis.

RESULTS

Overall, 673 audits were completed. After ZINC™ implementation, the IPC team performed a high median audit rate (100%), with a positive level change that approached statistical significance (+12.5 pp; P = 0.053). The median delays from the detection of positive samples to notification of the IPC team and from notification to audit completion decreased from 1 to 0 days and from 3 to 1 day, respectively (P < 0.001). Compared with the postcoronavirus disease (COVID)/pre-ZINC™ period, overall compliance with the C. difficile isolation bundle increased according to both level (+21.5 pp; P < 0.001) and trend (+1.6 pp/month; P = 0.002). Most trends of the isolation components improved, especially the availability of hand hygiene products (+1.0 pp/month; P = 0.02), medical prescriptions of contact precautions (+1.2 pp/month; P = 0.04) and isolation signage (+1.2 pp/month; P = 0.15).

CONCLUSION

Implementation of the ZINC™ electronic surveillance system improved both the timeliness of the IPC team response (alert-to-audit delay reduced from 3 to 1 day) and overall compliance with the isolation bundle (from nearly 20% before the implementation of the system in 2022 to approximately 40-50% after) in the management of C. difficile infection.