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Infect Control Hosp Epidemiol. 2017 Nov;38(11):1351-1357. doi: 10.1017/ice.2017.208. Epub 2017 Sep 26.

The Impact of Recurrent Clostridium difficile Infection on Patients' Prevention Behaviors.

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1Public Health Sciences,Loyola University,Chicago,Illinois.
3Department of Medicine,Cook County Health & Hospitals System,Rush University Medical Center,Chicago,Illinois.
2Center of Innovation for Complex Chronic Healthcare (CINCCH),Hines Veterans Affairs Hospital,Hines,Illinois.
5Center for Health Care Studies,Institute for Public Health and Medicine,Northwestern University,Chicago,Illinois.
7Health Sciences Division,Loyola University,Maywood,Illinois.
8Division of Infectious Diseases and Global Health,Department of Medicine,University of Chicago,Chicago,Illinois.
9Division of Infectious Diseases,College of Medicine,University of Illinois at Chicago,Chicago,Illinois.
11Division of Infectious Diseases,Loyola University Medical Center,Chicago,Illinois.
13Department of Clinical Microbiology and Infectious Diseases,NorthShore University Health System,Evanston,Illinois.
14Department of Family Medicine,NorthShore University Health System,Evanston,Illinois.
16Edward Hines,Jr., Veterans Affairs Hospital,Hines,Illinois.


OBJECTIVE To determine the impact of recurrent Clostridium difficile infection (RCDI) on patient behaviors following illness. METHODS Using a computer algorithm, we searched the electronic medical records of 7 Chicago-area hospitals to identify patients with RCDI (2 episodes of CDI within 15 to 56 days of each other). RCDI was validated by medical record review. Patients were asked to complete a telephone survey. The survey included questions regarding general health, social isolation, symptom severity, emotional distress, and prevention behaviors. RESULTS In total, 119 patients completed the survey (32%). On average, respondents were 57.4 years old (standard deviation, 16.8); 57% were white, and ~50% reported hospitalization for CDI. At the time of their most recent illness, patients rated their diarrhea as high severity (58.5%) and their exhaustion as extreme (30.7%). Respondents indicated that they were very worried about getting sick again (41.5%) and about infecting others (31%). Almost 50% said that they have washed their hands more frequently (47%) and have increased their use of soap and water (45%) since their illness. Some of these patients (22%-32%) reported eating out less, avoiding certain medications and public areas, and increasing probiotic use. Most behavioral changes were unrelated to disease severity. CONCLUSION Having had RCDI appears to increase prevention-related behaviors in some patients. While some behaviors are appropriate (eg, handwashing), others are not supported by evidence of decreased risk and may negatively impact patient quality of life. Providers should discuss appropriate prevention behaviors with their patients and should clarify that other behaviors (eg, eating out less) will not affect their risk of future illness. Infect Control Hosp Epidemiol. 2017;38:1351-1357.

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