Key Points
➤ Encourage appropriate use of antimicrobials by implementing an
antimicrobial stewardship program.
➤ Implement diagnostic stewardship practices for appropriate use and
interpretation of C. difficile testing.
➤ Assess adequacy of room cleaning.
➤ This pocket guide highlights practical recommendations to assist acute
care hospitals in implementing and prioritizing Clostridioides difficile
infection (CDI) prevention efforts.
➤ It is based on a synthesis of evidence, theoretical rationale, current
practices, practical considerations, author consensus, and consideration
of potential harm, where applicable.
➤ No guideline or expert guidance document can anticipate all clinical
situations. This pocket guide is not meant to be a substitute for individual
clinical judgment by qualified professionals.
Quality of Evidence
a
Category Definition
H = High Highly confident that the true effect lies close to that of the estimated size
and direction of the effect, for example, when there are a wide range of
studies with no major limitations, there is little variation between studies,
and the summary estimate has a narrow confidence interval.
M = Moderate
e true effect is likely to be close to the estimated size and direction of the
effect, but there is a possibility that it is substantially different, for example,
when there are only a few studies and some have limitations but not major
flaws, there is some variation between studies, or the confidence interval of
the summary estimate is wide.
L = Low e true effect may be substantially different from the estimated size and
direction of the effect, for example, when supporting studies have major
flaws, there is important variation between studies, the confidence interval
of the summary estimate is very wide, or there are no rigorous studies.
a
Based on the Centers for Disease Control and Prevention (CDC) Healthcare Infection Control Practices
Advisory Committee (HICPAC)
"Update to the Centers for Disease Control and Prevention and the Healthcare Infection Control
Practices Advisory Committee Recommendations Categorization Scheme for Infection Control and
Prevention Guideline Recommendations" (October 2019), the Grades of Recommendation, Assessment,
Development, and Evaluation (GRADE), and the Canadian Task Force on Preventive Health Care.
