2418. Determining the Impact of Visitor Contact Precautions on Hospital-Onset Clostridioides difficile Infection Rates: An Agent-Based Simulation Modeling Approach

BACKGROUND: Visitor contact precautions (VCP) have been suggested to reduce the transmission of Clostridiodes difficile at healthcare institutions. However, there are no data describing the impact of VCP on hospital-acquired C. difficile infection (HO-CDI) rates. Enforcing VCP for CDI control is also controversial, as VCP are poorly implemented and highly variable. METHODS: We developed an agent-based simulation model of C. difficile transmission at a model 200-bed acute-care adult hospital. Our agent-based simulation model represented interactions among the physicians, nurses, patients, visitors, and physical environment. We used the agent-based simulation model to evaluate the impact of VCP on reducing HO-CDI considering many different hospital settings and various assumptions on patient susceptibility, adherence rates to other infection control practices, interactions between healthcare workers and patients. RESULTS: VCP did not reduce the CDC-defined HO-CDI rates by more than 1% in any of the tested scenarios and hospital settings. Increasing the adherence of hand hygiene of healthcare workers to 56% from a baseline estimate of 55%, or compliance to room cleaning to 50% from a baseline estimate of 47% have led to higher rates of reduction in CDI compared with VCP. CONCLUSION: This is the first mathematical model to quantify the reduction in HO-CDI with VCP. The agent-based simulation model suggests that the impact of VCP on hospital-onset CDI is minimal and hospitals can achieve a higher rate of reduction for HO-CDI by implementing other interventions such as healthcare worker hand hygiene, environmental cleaning and healthcare worker contact precautions. Further studies are needed to evaluate the impact of VCP on C. difficile colonization in community. DISCLOSURES: All authors: No reported disclosures.