The Construction of a Decision-Making Evaluation System for Clostridium difficile Management Based on AHP and FCE

The Construction of a Decision-Making Evaluation System for Clostridium difficile Management Based on AHP and FCE | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The Construction of a Decision-Making Evaluation System for Clostridium difficile Management Based on AHP and FCE Zhou Gui, Fu Youyun, Feng Lei, Liu Jing, Zhong Jing, Ma Fujun, and 1 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-8061011/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To master the current status of Clostridium difficile management in medical institutions and provide a scientific basis for establishing intervention strategies by constructing a decision-making support and evaluation system for Clostridium difficile management. Methods From August 1, 2024 to March 31, 2025, multiple research methods including literature review, expert consultation, Analytic Hierarchy Process (AHP), and Fuzzy Comprehensive Evaluation (FCE) were employed.All research methods adhere to the expert method principle, and the professional version of yaahp 12.12 was used as the analysis software. All research protocols have been approved by the Ethics Committee of Chengdu Fifth People's Hospital. Informed consent forms have been obtained from all research subjects themselves[Ethics Approval No.: Lunshen 2023-016 (Sci.)-01]. Results The weights of first-level indicators in descending order were: Isolation and Treatment (0.3215), Cleaning and Disinfection (0.2466), System Requirements (0.1437), Training and Education (0.0979), Special Identification (0.0789), Monitoring (0.0696), and Material Preparation (0.0418). The top 5 second-level indicators by weight were: Single-room isolation or cohort isolation of patients (0.1610), Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office) (0.1076), Strict grouping and fixation of nursing staff for Clostridium difficile patients (0.0832), Clostridium difficile screening for high-risk patients (0.0730), and Implementation of corresponding disinfection levels for reusable instruments based on risk assessment (0.0567). Conclusion This decision-making support system enables hospital administrators to understand the status of Clostridium difficile management, contributes to optimizing resource allocation and establishing dynamic intervention measures, and is worthy of promotion and application. Health sciences/Diseases Health sciences/Health care Health sciences/Medical research Health sciences/Risk factors Clostridium difficile Analytic Hierarchy Process Fuzzy Comprehensive Evaluation Decision Support System Evaluation 1 Introduction With the improvement of medical conditions and the widespread use of antibiotics, Clostridioides difficile infection (CDI), a disease caused by an iatrogenic opportunistic pathogen, has shown a significant upward trend globally. This pathogen not only causes severe symptoms such as diarrhea and pseudomembranous colitis in patients but also poses a persistent threat to the public health system due to its high incidence and epidemic characteristics [ 1 ]. Statistics indicate that in the United States alone, over 500,000 hospitalizations are attributed to CDI annually, with associated medical costs reaching billions of US dollars [ 2 ]. As the hospital infection monitoring network improves, the detection rate of CDI has also exhibited an exponential growth trend, making it a major challenge in the field of hospital infection control [ 3 ].Current studies mainly focus on the analysis of etiological characteristics, molecular epidemiological tracking, and exploration of drug resistance mechanisms of CDI [ 4 ]. At the management and decision-making level, some scholars have used mathematical models for infection prediction, which plays a significant role in disease control. However, existing studies still have two common limitations: first, infection prediction fails to effectively integrate clinical diagnosis and treatment data with infection control factors; second, there is a lack of quantitative analysis of multiple uncertain factors in the decision-making process [ 5 ].The Analytic Hierarchy Process (AHP) and Fuzzy Comprehensive Evaluation (FCE) have achieved remarkable results in fields such as the optimization of medical resource allocation and hospital risk assessment [ 6 – 8 ]. As mature decision analysis tools, they can effectively address these issues. Nevertheless, their application in the field of CDI management has not been reported in relevant studies. Based on the aforementioned research gaps, this study innovatively constructs an integrated AHP-FCE model to solve the multi-criteria decision-making problems in CDI management. By establishing a quantitative evaluation system and an intelligent decision support system, this study aims to provide medical institutions with scientific and operable management schemes, which hold important theoretical value and practical significance for improving the efficiency of hospital infection prevention and control and reducing the risk of CDI transmission. 2 Materials and Methods 2.1 Expert Selection and Indicator Scoring Experts in relevant fields including hospital infection management, public health, clinical medicine, and nursing were selected. The inclusion criteria for experts were: 1. Having worked in the field for 5 years; 2. Engaged in infectious disease-related management work in the past 2 years; 3. Holding an intermediate or higher professional and technical title. The exclusion criteria were: 1. Having worked in the field for less than 5 years; 2. Not engaged in infectious disease management and treatment-related work in the past 2 years; 3. Holding a primary professional and technical title; 4. Unwilling to participate in this study. Experts were invited via email to analyze and judge the initially screened indicators, and conduct quantitative evaluations from the perspectives of importance, representativeness, and feasibility. 2.2 Construction of the Evaluation System The management requirements for Clostridium difficile were identified through literature retrieval, network search, brainstorming, media report cases, guideline and specification requirements, government document requirements, and on-site investigations, and the core elements requiring attention in Clostridium difficile management in medical institutions were determined. From August 1, 2024 to March 31, 2025, through two rounds of the Delphi method, the first-level and second-level indicators of the decision support system for Clostridium difficile management in medical institutions were confirmed. The weights of the first-level and second-level indicators of the decision support system for Clostridium difficile management were calculated again using the expert group decision AHP method. Finally, the FCE was used to process the management status in the decision-making process, thus forming the Clostridium difficile management evaluation system. 2.3 Calculation of Indicator Weights Experts scored the relative importance of the listed indicators, and the assignment was carried out using the principle of indicator value sorting and partitioning. The actual indicator data were sorted from low to high, a judgment matrix was constructed, and the indicator weight values were calculated. There were 7 first-level indicators: System Requirements, Special Identification, Material Preparation, Monitoring, Cleaning and Disinfection, Isolation and Treatment, and Training and Education; and 40 second-level indicators, including the soundness of the hospital Clostridium difficile management system, the implementation of first-level quality control for Clostridium difficile prevention and control in departments, and the implementation of second-level quality control and reward and punishment systems for Clostridium difficile in hospitals. 2.4 Statistical Analysis The professional version of yaahp12.12 was used to generate the expert questionnaire for the Clostridium difficile management decision support system. The expert questionnaires were distributed in a targeted manner. After the questionnaires were collected, all data were subject to completeness verification, quality review, and logical error correction by special personnel, then imported into the software. The weight coefficients of each evaluation indicator were calculated through group decision-making, and then the FCE was used to complete the Clostridium difficile management decision evaluation system. 3 Results 3.1 Basic Information The positive coefficients of the two rounds of expert consultation were 91.30% and 100%, the authority coefficients were 0.842 and 0.891, and the coordination coefficients were 0.370 and 0.425. A total of 23 experts were selected for consultation in this study, involving professionals from hospital infection management, clinical doctors, clinical nurses, public health management and other departments of medical institutions. The ratio of male to female experts was 1:1.9, with an average age of (42.26 ± 5.79) years. Among them, 18 experts (75.0%) had a bachelor's degree or below, 2 (8.3%) had a master's degree, and 3 (12.5%) had a doctoral degree; 13 experts (54.1%) held intermediate titles, 5 (20.8%) held associate senior titles, and 5 (20.8%) held senior titles; currently, 18 experts (75.0%) are mainly engaged in health management, 2 (8.3%) in disease control work, and 3 (12.5%) in clinical medical work; 5 experts (20.8%) have worked in the profession for 5 years or less, 5 (20.8%) for 5 to 10 years, 5 (20.8%) for 10 to 15 years, 3 (12.5%) for 15 to 20 years, and 5 (20.8%) for more than 20 years; none of the experts have participated in previous studies related to Clostridium difficile management decisions; 19 experts (79.1%) are from tertiary medical institutions, 2 (8.3%) from secondary medical institutions, and 2 (8.3%) from ungraded institutions. 3.2 Clostridium difficile Management Decision Support System The AHP-based model generally consists of three parts: the decision-making layer, the middle layer, and the scheme layer. In this study, relevant indicators were determined through literature review and interviews with experts in fields such as hospital infection, clinical medicine, nursing, and public health. Seven intermediate indicators affecting the Clostridium difficile management decision support system were identified, and then 40 sub-layer indicators were divided. 3.2.1 Ranking Weights of Elements in the Scheme Layer for the Decision-Making Objective Through the group decision-making method, the arithmetic mean method was adopted for the judgment matrix, and the matrix consistency was 0.0985. The ranking results of the weights of each element included in the model are shown in Table 1 . The combined consistency of each element in the criterion layer for Clostridium difficile management is shown in Table 2 . Table 1 Ranking Weights of Elements in the Scheme Layer for the Decision-Making Objective Alternative Scheme Weight Ranking Alternative Scheme Weight Ranking 5.1 Single-room isolation or cohort isolation of patients 0.1610 1 1.2 Departmental implementation of first-level quality control for Clostridium difficile prevention and control 0.0122 21 4.2 Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office) 0.1076 2 3.1 Provision of rapid hand sanitizer and gloves at the patient's bedside 0.0099 22 5.2 Strict grouping and fixation of nursing staff for Clostridium difficile patients 0.0832 3 1.3 Hospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile 0.0089 23 6.2 Clostridium difficile screening for high-risk patients 0.0730 4 1.4 Active screening for colonizing bacteria in key patient groups by departments 0.0087 24 4.1 Implementation of corresponding disinfection levels for reusable instruments based on risk assessment 0.0567 5 2.4 Patients wearing Clostridium difficile identification wristbands 0.0085 25 5.3 Isolation orders must be issued within 30 minutes 0.0533 6 7.5 Diagnostic and therapeutic operations for Clostridium difficile patients to be performed last 0.0068 26 4.4 Cleaning and disinfection of bed units of Clostridium difficile patients to be performed last 0.0532 7 7.8 Training on hand hygiene for medical staff 0.0066 27 4.3 Daily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination) 0.0472 8 7.1 Regular training on Clostridium difficile prevention and control conducted by departments 0.0056 28 1.5 Timely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections 0.0305 9 3.4 Medical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations 0.0052 29 5.4 Precise treatment of Clostridium difficile patients by doctors 0.0298 10 1.9 Rationality of handling related stakeholders 0.0050 30 1.6 Laboratory telephone reporting to clinical departments 0.0279 11 7.7 Strict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors 0.0049 31 2.3 Posting of isolation signs at the patient's bedside 0.0227 12 7.4 Medical staff in departments familiar with the detection trend of Clostridium difficile in their own departments 0.0042 32 5.5 Lifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals 0.0223 13 1.7 Domestic waste of Clostridium difficile patients disposed of as medical waste 0.0035 33 6.1 Regular environmental hygiene monitoring in areas where Clostridium difficile patients are located 0.0214 14 7.3 All staff in clinical departments aware of basic information of Clostridium difficile patients 0.0034 34 4.5 Regular emptying and disinfection of wards where Clostridium difficile patients are admitted 0.0206 15 1.8 Standardized disposal of medical waste from Clostridium difficile patients 0.0033 35 1.1 Soundness of the hospital Clostridium difficile management system 0.0204 16 2.1 Isolation signs affixed to patient medical records 0.0029 36 2.2 Implementation of Clostridium difficile marking in information system test application forms 0.0167 17 3.6 Handwashing sinks in areas where patients are located dedicated to hand hygiene 0.0028 37 7.6 Notifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients 0.0157 18 3.3 Isolation gowns provided at the patient's bedside and replaced daily 0.0027 38 3.5 Diagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner 0.0153 19 7.2 Health education on Clostridium difficile prevention and control for patients and their families 0.0023 39 6.3 Regular monitoring of hand hygiene of staff 0.0125 20 3.2 Covered medical waste bins provided at the patient's bedside 0.0015 40 Table 2 Combined Consistency of Each Element in the Criterion Layer for Clostridium difficile Management Criterion Layer Elements Weight CI RI (Order) 5 Isolation and Treatment 0.3497 0.0404 1.1200 (5) 4 Cleaning and Disinfection 0.2854 0.0990 1.1200 (5) 1 System Requirements 0.1204 0.1430 1.4600 (9) 6 Monitoring 0.1069 0.0123 0.5200 (3) 2 Special Identification 0.0509 0.0847 0.8900 (4) 7 Training and Education 0.0494 0.1128 1.4100 (8) 3 Material Preparation 0.0374 0.1154 1.2600 (6) 3.2.2 Indicators and Weights of the Clostridium difficile Management Decision Support Evaluation Scale Through the Delphi method, the middle layer of first-level indicators of the Clostridium difficile management decision support evaluation scale was determined, including 7 indicators: System Requirements, Special Identification, Material Preparation, Monitoring, Cleaning and Disinfection, Isolation and Treatment, and Training and Education. The scheme layer of second-level indicators includes 40 indicators such as the soundness of the hospital Clostridium difficile management system and the implementation of first-level quality control for Clostridium difficile prevention and control in departments. The specific importance of each indicator is shown in Table 3 . Table 3 Indicators and Weights of the Clostridium difficile Management Decision Support Evaluation Scale First-level Indicators Weight Second-level Indicators Explanation of Second-level Indicators Weight 1 System Requirements 0.1204 1.1 Soundness of the hospital Clostridium difficile management system The hospital has a Clostridium difficile prevention and control plan 0.0204 1.2 Departmental implementation of first-level quality control for Clostridium difficile prevention and control SOP for Clostridium difficile prevention and control and daily operation records 0.0122 1.3 Hospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile Supervision and assessment records of Clostridium difficile management 0.0089 1.4 Active screening for colonizing bacteria in key patient groups by departments The situation of Clostridium difficile screening for key groups by departments 0.0087 1.5 Timely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections Handling of 2 or more cases of Clostridium difficile in the same ward 0.0305 1.6 Laboratory telephone reporting to clinical departments Telephone notification of Clostridium difficile results to clinical departments 0.0279 1.7 Domestic waste of Clostridium difficile patients disposed of as medical waste All domestic waste generated by Clostridium difficile patients is managed as medical waste 0.0035 1.8 Standardized disposal of medical waste from Clostridium difficile patients No risk of cross-contamination in the management of medical waste generated by Clostridium difficile patients 0.0033 1.9 Rationality of handling related stakeholders Considering the rights of various personnel in Clostridium difficile management 0.0050 2 Special Identification 0.0509 2.1 Isolation signs affixed to patient medical records Contact isolation signs affixed to the cover of medical records 0.0029 2.2 Implementation of Clostridium difficile marking in information system test application forms Special marks for Clostridium difficile patients on test application forms 0.0167 2.3 Posting of isolation signs at the patient's bedside Contact isolation signs at obvious positions of the bed units of Clostridium difficile patients 0.0227 2.4 Patients wearing Clostridium difficile identification wristbands Patients wear identification wristbands on their wrists or ankles 0.0085 3 Material Preparation 0.0374 3.1 Provision of rapid hand sanitizer and gloves at the patient's bedside Special gloves and hand sanitizer prepared for each bed unit 0.0099 3.2 Covered medical waste bins provided at the patient's bedside At least one covered medical waste bin provided in each patient's bed unit 0.0015 3.3 Isolation gowns provided at the patient's bedside and replaced daily Disposable isolation gowns or visitor gowns provided at the bedside, replaced daily 0.0027 3.4 Medical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations Isolation gowns required for any operations involving physical contact 0.0052 3.5 Diagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner Diagnostic and therapeutic supplies and cleaning tools are used exclusively by one patient and disinfected in a timely manner 0.0153 3.6 Handwashing sinks in areas where patients are located dedicated to hand hygiene Handwashing sinks for medical staff's hand hygiene around Clostridium difficile patients are only used for handwashing 0.0028 4 Cleaning and Disinfection 0.2854 4.1 Implementation of corresponding disinfection levels for reusable instruments based on risk assessment Reusable instruments are disinfected according to low, medium, and high risks 0.0567 4.2 Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office) Cleaning staff engaged in the cleaning and disinfection of patient bed units need professional training 0.1076 4.3 Daily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination) The surface of objects in the bed units of Clostridium difficile patients is cleaned and disinfected no less than twice a day 0.0472 4.4 Cleaning and disinfection of bed units of Clostridium difficile patients to be performed last The cleaning and disinfection of bed units of Clostridium difficile patients are completed after those of other patients 0.0532 4.5 Regular emptying and disinfection of wards where Clostridium difficile patients are admitted All hospital beds in wards admitting Clostridium difficile patients are thoroughly disinfected regularly 0.0206 5 Isolation and Treatment 0.3497 5.1 Single-room isolation or cohort isolation of patients Clostridium difficile patients live alone or all Clostridium difficile patients are concentrated in the same ward 0.1610 5.2 Strict grouping and fixation of nursing staff for Clostridium difficile patients Medical and nursing staff fixed to provide care for Clostridium difficile patients 0.0832 5.3 Isolation orders must be issued within 30 minutes After the department receives the Clostridium difficile report, the isolation order is implemented within 30 minutes 0.0533 5.4 Precise treatment of Clostridium difficile patients by doctors Standardized medication for the treatment of Clostridium difficile patients by doctors 0.0298 5.5 Lifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals Diarrhea symptoms disappear, and two Clostridium difficile tests are negative 0.0223 6 Monitoring 0.1069 6.1 Regular environmental hygiene monitoring in areas where Clostridium difficile patients are located The ward conducts surface monitoring of areas where Clostridium difficile patients have stayed 0.0214 6.2 Clostridium difficile screening for high-risk patients The ward conducts Clostridium difficile screening for patients with diarrhea and unformed stools 0.0730 6.3 Regular monitoring of hand hygiene of staff Hand hygiene monitoring is conducted quarterly in wards where Clostridium difficile patients are located 0.0125 7 Training and Education 0.0494 7.1 Regular training on Clostridium difficile prevention and control conducted by departments All staff in the department receive training on Clostridium difficile prevention and control 0.0056 7.2 Health education on Clostridium difficile prevention and control for patients and their families Records of training received by Clostridium difficile patients and their families 0.0023 7.3 All staff in clinical departments aware of basic information of Clostridium difficile patients Medical staff in the ward are familiar with the bed numbers of Clostridium difficile patients 0.0034 7.4 Medical staff in departments familiar with the detection trend of Clostridium difficile in their own departments Medical staff in the ward are familiar with the detection trend of Clostridium difficile in their own ward 0.0042 7.5 Diagnostic and therapeutic operations for Clostridium difficile patients to be performed last Medical staff place Clostridium difficile patients last during diagnostic and therapeutic activities 0.0068 7.6 Notifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients Before transferring Clostridium difficile patients who have not been lifted from isolation, the receiving department must be notified by telephone 0.0157 7.7 Strict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors External personnel and consulting doctors implement relevant prevention and control measures when contacting Clostridium difficile patients 0.0049 7.8 Training on hand hygiene for medical staff All medical staff in the ward receive hand hygiene training 0.0066 3.2.3 Construction of the Clostridium difficile Management Decision Evaluation Scale by Combining AHP and FCE After determining the weight coefficients of each evaluation indicator using AHP, the evaluation scale was directly generated. The Clostridium difficile management decision evaluation scale includes the evaluator's name, unit, and evaluation object. This scale contains 40 evaluation indicators. According to the explanation of the evaluation indicators, the evaluation grade (Excellent, Good, Fair, Poor) is selected to obtain the specific evaluation score. The specific details are shown in Table 4 . Table 4 Clostridium difficile Management Decision Evaluation Scale Based on AHP and FCE No. Evaluation Indicators Explanation of Evaluation Indicators 1 Soundness of the hospital Clostridium difficile management system The hospital has a Clostridium difficile prevention and control plan 2 Departmental implementation of first-level quality control for Clostridium difficile prevention and control SOP for Clostridium difficile prevention and control and daily operation records 3 Hospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile Supervision and assessment records of Clostridium difficile management 4 Active screening for colonizing bacteria in key patient groups by departments The situation of Clostridium difficile screening for key groups by departments 5 Timely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections Handling of 2 or more cases of Clostridium difficile in the same ward 6 Laboratory telephone reporting to clinical departments Telephone notification of Clostridium difficile results to clinical departments 7 Domestic waste of Clostridium difficile patients disposed of as medical waste All domestic waste generated by Clostridium difficile patients is managed as medical waste 8 Standardized disposal of medical waste from Clostridium difficile patients No risk of cross-contamination in the management of medical waste generated by Clostridium difficile patients 9 Rationality of handling related stakeholders Considering the rights of various personnel in Clostridium difficile management 10 Isolation signs affixed to patient medical records Contact isolation signs affixed to the cover of medical records 11 Implementation of Clostridium difficile marking in information system test application forms Special marks for Clostridium difficile patients on test application forms 12 Posting of isolation signs at the patient's bedside Contact isolation signs at obvious positions of the bed units of Clostridium difficile patients 13 Patients wearing Clostridium difficile identification wristbands Patients wear identification wristbands on their wrists or ankles 14 Provision of rapid hand sanitizer and gloves at the patient's bedside Special gloves and hand sanitizer prepared for each bed unit 15 Covered medical waste bins provided at the patient's bedside At least one covered medical waste bin provided in each patient's bed unit 16 Isolation gowns provided at the patient's bedside and replaced daily Disposable isolation gowns or visitor gowns provided at the bedside, replaced daily 17 Medical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations Isolation gowns required for any operations involving physical contact 18 Diagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner Diagnostic and therapeutic supplies and cleaning tools are used exclusively by one patient and disinfected in a timely manner 19 Handwashing sinks in areas where patients are located dedicated to hand hygiene Handwashing sinks for medical staff's hand hygiene around Clostridium difficile patients are only used for handwashing 20 Implementation of corresponding disinfection levels for reusable instruments based on risk assessment Reusable instruments are disinfected according to low, medium, and high risks 21 Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office) Cleaning staff engaged in the cleaning and disinfection of patient bed units need professional training 22 Daily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination) The surface of objects in the bed units of Clostridium difficile patients is cleaned and disinfected no less than twice a day 23 Cleaning and disinfection of bed units of Clostridium difficile patients to be performed last The cleaning and disinfection of bed units of Clostridium difficile patients are completed after those of other patients 24 Regular emptying and disinfection of wards where Clostridium difficile patients are admitted All hospital beds in wards admitting Clostridium difficile patients are thoroughly disinfected regularly 25 Single-room isolation or cohort isolation of patients Clostridium difficile patients live alone or all Clostridium difficile patients are concentrated in the same ward 26 Strict grouping and fixation of nursing staff for Clostridium difficile patients Medical and nursing staff fixed to provide care for Clostridium difficile patients 27 Isolation orders must be issued within 30 minutes After the department receives the Clostridium difficile report, the isolation order is implemented within 30 minutes 28 Precise treatment of Clostridium difficile patients by doctors Standardized medication for the treatment of Clostridium difficile patients by doctors 29 Lifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals Diarrhea symptoms disappear, and two Clostridium difficile tests are negative 30 Regular environmental hygiene monitoring in areas where Clostridium difficile patients are located The ward conducts surface monitoring of areas where Clostridium difficile patients have stayed 31 Clostridium difficile screening for high-risk patients The ward conducts Clostridium difficile screening for patients with diarrhea and unformed stools 32 Regular monitoring of hand hygiene of staff Hand hygiene monitoring is conducted quarterly in wards where Clostridium difficile patients are located 33 Regular training on Clostridium difficile prevention and control conducted by departments All staff in the department receive training on Clostridium difficile prevention and control 34 Health education on Clostridium difficile prevention and control for patients and their families Records of training received by Clostridium difficile patients and their families 35 All staff in clinical departments aware of basic information of Clostridium difficile patients Medical staff in the ward are familiar with the bed numbers of Clostridium difficile patients 36 Medical staff in departments familiar with the detection trend of Clostridium difficile in their own departments Medical staff in the ward are familiar with the detection trend of Clostridium difficile in their own ward 37 Diagnostic and therapeutic operations for Clostridium difficile patients to be performed last Medical staff place Clostridium difficile patients last during diagnostic and therapeutic activities 38 Notifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients Before transferring Clostridium difficile patients who have not been lifted from isolation, the receiving department must be notified by telephone 39 Strict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors External personnel and consulting doctors implement relevant prevention and control measures when contacting Clostridium difficile patients 40 Training on hand hygiene for medical staff All medical staff in the ward receive hand hygiene training 4 Discussion The prevention and control of healthcare-associated infections caused by Clostridium difficile have always attracted great attention. Healthcare-associated infection prevention and control involve many management measures, including correct contact precautions, handwashing with soap and water, use of gloves, thorough cleaning of medical equipment and the environment around patients, and rational use of antibiotics [ 9 ]. However, the implementation and execution of some prevention and control measures are restricted by the specific scenarios of medical institutions. It is particularly important to implement prevention and control measures under scientific guidance and consider the priority of various measures. The combination of AHP and FCE can effectively solve this problem. 4.1 Significant Differences in the Importance of Each Element in the Scheme Layer in the Clostridium difficile Management Decision Evaluation In CDI management, the indicator weights of the decision support system reflect the relative importance of various measures in prevention and control. Isolation and Treatment (0.3497) and Cleaning and Disinfection (0.2854) are the two core measures, while the weights of System Requirements, Training and Education, Special Identification, Monitoring, and Material Preparation decrease in sequence.Isolation and Treatment have the highest weight in CDI management, indicating their core position in prevention and control. CDI is highly contagious, and spores in patients' feces can survive in the environment for a long time. Therefore, timely isolation of infected patients is the key to blocking the transmission chain [ 10 ]. In addition, early diagnosis and standardized treatment can effectively reduce the severity of the disease and the recurrence rate [ 11 ]. Studies have shown that delayed treatment is significantly associated with patient mortality [ 12 ]; thus, the high weight of Isolation and Treatment reflects its priority in clinical practice.Cleaning and Disinfection is the second most important measure for Clostridium difficile prevention and control. Clostridium difficile spores are highly resistant to conventional disinfectants, so high-efficiency disinfectants such as chlorine-containing disinfectants or hydrogen peroxide must be used [ 13 ]. Consistent with previous results, inadequate environmental cleaning is one of the main risk factors for the transmission of Clostridium difficile in hospitals [ 14 ]. In addition, the cleaning and disinfection of high-frequency contact surfaces are particularly important, as these areas may become intermediaries for spore transmission [ 15 ]. The high weight of Cleaning and Disinfection highlights its key role in blocking environmental transmission.System Requirements include the formulation and implementation of hospital infection control policies, such as hand hygiene standards and antibiotic management strategies. The abuse of antibiotics is one of the main incentives for CDI, so antibiotic management is an important part of prevention and control [ 16 ]. Studies have shown that the implementation of strict antibiotic management policies can significantly reduce the CDI rate [ 17 ]. In addition, the implementation of hand hygiene systems is also a key part of prevention and control. Although Clostridium difficile spores are not sensitive to alcohol-based hand sanitizers, handwashing with soap and water can effectively remove spores [ 18 ].Training and Education are important means to improve the prevention and control awareness of medical staff and patients. Consistent with previous research results, the lack of knowledge of CDI prevention and control among medical staff is one of the main reasons for the inadequate implementation of prevention and control measures [ 19 ]. Through regular training and education, the compliance of medical staff with measures such as isolation, cleaning and disinfection, and hand hygiene can be improved [ 20 ]. In addition, educating patients and their families also helps to reduce the risk of healthcare-associated transmission.Special Identification is used to remind medical staff and visitors of infection risks. Studies have shown that a clear identification system can improve the compliance of medical staff with infection prevention and control measures [ 21 ]. However, the weight of Special Identification is relatively low, which may be because its role is more auxiliary rather than a direct intervention measure.Monitoring includes the tracking and analysis of CDI rate, recurrence rate, and antibiotic use. Monitoring data can provide a scientific basis for hospital infection control and help identify high-risk areas and populations [ 22 ]. However, the weight of Monitoring is relatively low, which may be because its role is more about post-evaluation rather than direct intervention.Material Preparation includes the reserve of disinfectants, protective equipment, and detection reagents. Although Material Preparation is the basis for prevention and control, its weight is the lowest, which may be because the supply of materials is relatively stable in most medical institutions, and its impact is more indirect.The indicator weights of the Clostridium difficile management decision support system reflect the relative importance of various measures in prevention and control. Isolation and Treatment and Cleaning and Disinfection are the two core measures, while the weights of System Requirements, Training and Education, Special Identification, Monitoring, and Material Preparation decrease in sequence. This weight distribution provides a scientific basis for hospital infection control and helps optimize resource allocation and prevention and control strategies. 4.2 Differences in the Importance of Each Element in the Middle Layer and Criterion Layer for the Clostridium difficile Management Decision Support System The weight ranking of the second-level indicators of the decision support system in CDI management reflects the relative importance of different intervention measures in infection control.Isolation is the core measure to block the transmission of Clostridium difficile. Clostridium difficile is mainly transmitted through contact, and its spores can survive in the environment for a long time. Isolating patients can significantly reduce the risk of cross-infection. The guidelines of the Centers for Disease Control and Prevention (CDC) emphasize that confirmed or suspected CDI patients should be given priority for single-room isolation; if resources are limited, cohort isolation in the same room is recommended, and dedicated toilets should be equipped [ 23 ]. Relevant studies have shown that timely isolation can reduce the incidence of CDI by more than 50% [ 24 ]; thus, the high weight of this measure reflects its primary position in blocking the infection chain. The fixed grouping of nursing staff aims to reduce cross-contamination caused by personnel movement. Dubberke et al. [ 25 ] pointed out that nursing staff may carry spores through their hands or work clothes, and fixed grouping can reduce the risk of transmission. A prospective study showed that after the implementation of group nursing, the transmission rate during CDI outbreaks decreased by 35% [ 26 ]. In addition, fixed teams help improve operational standardization, thereby strengthening the prevention and control effect.Inadequate disinfection of medical devices may become an important medium for the transmission of Clostridium difficile. Rutala et al. [ 27 ] proposed that disinfection should be carried out according to the risk classification of instruments contacting patients' mucous membranes or sterile sites. The guidelines of the American Society for Gastrointestinal Endoscopy emphasize that most CDI outbreaks related to endoscopes are associated with defects in the disinfection process, and strict implementation of hierarchical disinfection can reduce such risks [ 28 ]. The weight of this measure reflects the key role of instrument management in infection control.The cleaning order affects the effect of environmental disinfection. Carling et al. [ 29 ] recommended following the principle of "from clean to dirty", that is, cleaning low-contamination areas first and handling high-risk areas last to avoid the spread of contamination. A simulation study showed that adjusting the cleaning order can reduce the spore load in the environment by 40% [ 30 ]. This measure improves the overall cleaning efficiency by optimizing the workflow, but its weight is relatively low, which may be due to the large differences in compliance with the order in actual operations.Frequent environmental disinfection can reduce spore residues. Faires et al. [ 31 ] found that daily cleaning of the environment around patients with chlorine-containing disinfectants (concentration > 1000 pp) can reduce the incidence of CDI by 30%. However, the weight of this measure is only fifth, which may be because some institutions are limited by manpower or costs and cannot fully implement it. It is worth noting that advocating immediate handling of contamination can further optimize environmental management [ 32 ].This study found that the weight of hand hygiene is not among the top five. Although hand hygiene is the cornerstone of CDI prevention and control, it did not rank in the top five. This may be because hand hygiene is already a common intervention measure in medical institutions, and its implementation rate has reached a high level, so its importance in CDI prevention and control is relatively weakened.Barriers to the implementation of prevention and control measures: Single-room isolation, a high-weight measure, may be limited by medical resources, so resource allocation needs to be optimized in combination with cost-benefit analysis [ 33 ].Impact of emerging technologies: The application of automated disinfection equipment may change the weight distribution of traditional cleaning and disinfection [ 34 ]. Future studies can further verify the synergistic effect of various measures in actual scenarios and explore dynamic weight models to adapt to the differences in resource allocation of different medical institutions. 4.3 Precautions for the Use of the Clostridium difficile Management Decision Support Evaluation System The application of the CDI management decision support evaluation system needs to be combined with clinical practice and evidence-based medical evidence. The following aspects require attention:First, standardize the detection process and result interpretation. Strict implementation of the stepwise detection strategy: The system should support the "two-step method" of glutamate dehydrogenase detection combined with toxin detection or nucleic acid amplification technology (NAAT) to reduce the false positive rate. Studies have shown that relying solely on NAAT may overestimate the incidence of CDI because it cannot distinguish colonization from infection [ 35 ]. Strict control of sample quality: Only water samples or watery stool samples are suitable for detection, and formed stool samples should be marked as "not applicable" by the system to avoid false negative results [ 24 ]. Comprehensive judgment combined with clinical background: Detection results need to be combined with patient symptoms, antibiotic use history, and laboratory indicators to avoid over-treatment of asymptomatic colonization [ 23 ].Second, dynamic adjustment of individualized treatment plans. Medication based on severity classification: Oral vancomycin or fidaxomicin is recommended for mild to moderate CDI, and intravenous metronidazole should be combined for severe or fulminant cases. The system should prompt that the failure rate of metronidazole monotherapy is high (20%–30%), and it is not recommended for severe patients [ 36 ]. Precise management of recurrent CDI: For the first recurrence, the course of vancomycin can be extended; for the second and subsequent recurrences, fidaxomicin or fecal microbiota transplantation (FMT) is recommended. The system should integrate the patient's immune status to assess the risk of FMT [ 37 ]. Synchronous management of antibacterial drugs: When initiating CDI treatment, the system should force a prompt to discontinue high-risk antibiotics and recommend narrow-spectrum alternative schemes to reduce intestinal flora disturbance [ 38 ].Third, implementation and optimization of infection control measures. Priority of isolation measures: Single-room isolation of patients or cohort isolation (centralized care) is the core of blocking transmission, with the highest weight (0.1363). Relevant studies have shown that delaying isolation for 24 hours can increase the transmission risk by 3 times [ 39 ]. Standardized operation of environmental disinfection: The system should prompt the use of chlorine-containing disinfectants to clean the environment around patients at least twice a day, and bed unit disinfection should be placed in the last step to avoid contamination spread [ 40 ]. Monitoring of nursing staff behavior: The system can integrate hand hygiene compliance monitoring data and fix nursing staff groups to reduce cross-infection. Relevant studies have shown that increasing hand hygiene compliance to > 90% can reduce the incidence of CDI by 40% [ 26 ].Fourth, data timeliness and multidisciplinary collaboration. Dynamic update mechanism of guidelines: The system should integrate the latest evidence-based evidence in real time to avoid decisions based on outdated strategies. Integration of multidisciplinary data: It is necessary to include surgical consultation indications (colon perforation), nutritional support schemes (priority to enteral nutrition), and microbiological data (highly virulent strain RT027) to provide interdisciplinary decision support [ 41 ].Fifth, patient risk assessment and early warning. Identification of high-risk groups: The system should automatically mark elderly patients (≥ 65 years old), patients with long-term use of proton pump inhibitors (PPI) or immunosuppressants, and issue early warnings of CDI risk. Previous studies have also shown that PPI use can increase the risk of CDI [ 42 ].Sixth, targeted solutions to implementation barriers. Institutions with limited resources can adopt "risk-stratified isolation" to give priority to isolating severe or high-transmission-risk patients [ 43 ]. Implement continuous quality improvement: Optimize processes through system feedback data and analyze the correlation between environmental disinfection compliance and CDI incidence [ 44 ].This study successfully constructed a Clostridium difficile management decision support system based on AHP and FCE. The design and application of the system demonstrate its effectiveness and practicality in dealing with complex medical decision-making problems and show its potential in improving the efficiency of CDI management. Despite the positive results, the study still has some limitations: the accuracy of the model is highly dependent on the quality of expert data, and the current indicator system may need to be updated with changes in medical practice. Future studies can consider introducing more real-time data and advanced data analysis technologies to improve the prediction ability and adaptability of the system. This study provides a powerful decision-making tool for CDI management, which can evaluate the current status of CDI management in medical institutions at all levels and lay a foundation for the research and application of other types of healthcare-associated infections in the future. With the continuous progress of technology and the improvement of methods, it is expected that this system will play a greater role in future medical management practice. Declarations Funding This study was supported by the Chengdu Medical Research Funding Project (Project No.: 2022402), the Sichuan Preventive Medicine Association Funding Project (Project No.: SYYXHPT202407), the Sichuan Science and Technology Department Funding Project (Project No.: 21RX0084), and the Chengdu Science and Technology Bureau Funding Project (Project No.: 2023-RK00-00160-ZF). Author Contribution Zhou Gui (Corresponding Author)¹: Conceived and designed the overall research framework; initiated the study on Clostridium difficile management decision support system; led the expert consultation process (including expert selection, indicator design, and questionnaire distribution); supervised data analysis and model construction (AHP and FCE); drafted the manuscript and revised it critically for important intellectual content; coordinated cross-institutional collaboration and finalized the submission version.Fu Youyun¹: Participated in the construction of the evaluation system; conducted systematic literature retrieval and collation (covering guidelines, government documents, and previous studies on Clostridium difficile management); assisted in designing primary and secondary indicators based on literature review and on-site investigations; verified the feasibility of indicators and contributed to the "Materials and Methods" section.Feng Lei²: Specialized in training and education-related content; designed training-related indicators in the evaluation system (e.g., specialized training for cleaning staff, regular training for medical staff); provided professional insights on the design of training and education modules; analyzed the weight results of training-related indicators and supplemented discussion on their practical application in the "Discussion" section.Liu Jing³: Contributed to expert consultation and data validation; invited and coordinated experts from hospital infection management field (especially from Southwest Medical University Affiliated Hospital); participated in two rounds of Delphi method consultation, collated expert feedback, and verified the rationality of indicator weights; assisted in analyzing the consistency of expert opinions and summarized the basic information of experts in the "Results" section.Zhong Jing⁴: Focused on material preparation and cleaning/disinfection-related indicators; provided professional perspectives on medical equipment disinfection (e.g., risk-based disinfection of reusable instruments) based on work experience in medical equipment department; verified the operability of material preparation indicators (e.g., provision of protective equipment at patient bedsides); supplemented literature on medical device disinfection standards to support the discussion.Ma Fujun⁵: Participated in monitoring and system requirements-related research; designed monitoring indicators (e.g., high-risk patient screening, environmental hygiene monitoring); analyzed the weight results of monitoring and system requirements modules; provided practical suggestions on the application of the decision support system in different levels of medical institutions (based on work experience in Ganzhou Third People's Hospital); revised the manuscript to enhance its clinical applicability. Acknowledgments he authors would like to express their sincere gratitude to Peng Ling from the Department of Hospital Infection Control of Chengdu No.2 People's Hospital, Zhou Zhufeng (Vice President of the University Hospital of Southwest Jiaotong University), Liu Ji from the Department of Hospital Infection Control of Yunnan No.3 People's Hospital, Zhang Zhanlin from the Department of Hospital Infection Control of Linxia Prefecture People's Hospital of Gansu Province, and other relevant individuals for their valuable support in the questionnaire survey during the research process. Their assistance has been instrumental in the smooth progress of this study. Data Availability This study has generated and used research data throughout the research process.Data GenerationExpert Consultation Data: From August 1, 2024 to March 31, 2025, two rounds of Delphi method consultations were conducted with 23 experts. Data such as expert demographic information (gender, age, education background, professional title, work experience, affiliated institution), and scoring results on the importance, representativeness, and feasibility of evaluation indicators were collected.Indicator Weight Data: Based on expert scoring, the yaahp 12.12 software was used to construct a judgment matrix, and the weight data of 7 first-level indicators and 40 second-level indicators in the Clostridium difficile management decision support system were calculated.Evaluation Scale Data: Combined with AHP and FCE, an evaluation scale containing 40 indicators was constructed, and the data framework for evaluating the management status through four grades (Excellent, Good, Fair, Poor) was formed.Data UsageStatistical Analysis: The collected expert consultation data and indicator scoring data were verified for completeness, reviewed for quality, and corrected for logical errors, then imported into the software for group decision-making calculation to determine the weight coefficient of each indicator.System Construction: The weight data and evaluation criteria data were used to build the Clostridium difficile management decision support and evaluation system, providing a quantitative basis for subsequent management status evaluation and intervention strategy formulation.Result Verification: The consistency of the judgment matrix (consistency ratio 0.0985) and the coordination coefficient of expert opinions (0.370, 0.425) were verified using the generated data to ensure the scientificity and reliability of the research results. 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13:29:49","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":1554939,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-8061011/v1/5769325b-9c1d-4332-9fb9-0105b7ceefd3.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Construction of a Decision-Making Evaluation System for Clostridium difficile Management Based on AHP and FCE","fulltext":[{"header":"1 Introduction","content":"\u003cp\u003eWith the improvement of medical conditions and the widespread use of antibiotics, Clostridioides difficile infection (CDI), a disease caused by an iatrogenic opportunistic pathogen, has shown a significant upward trend globally. This pathogen not only causes severe symptoms such as diarrhea and pseudomembranous colitis in patients but also poses a persistent threat to the public health system due to its high incidence and epidemic characteristics [\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]. Statistics indicate that in the United States alone, over 500,000 hospitalizations are attributed to CDI annually, with associated medical costs reaching billions of US dollars [\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]. As the hospital infection monitoring network improves, the detection rate of CDI has also exhibited an exponential growth trend, making it a major challenge in the field of hospital infection control [\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e].Current studies mainly focus on the analysis of etiological characteristics, molecular epidemiological tracking, and exploration of drug resistance mechanisms of CDI [\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e]. At the management and decision-making level, some scholars have used mathematical models for infection prediction, which plays a significant role in disease control. However, existing studies still have two common limitations: first, infection prediction fails to effectively integrate clinical diagnosis and treatment data with infection control factors; second, there is a lack of quantitative analysis of multiple uncertain factors in the decision-making process [\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e].The Analytic Hierarchy Process (AHP) and Fuzzy Comprehensive Evaluation (FCE) have achieved remarkable results in fields such as the optimization of medical resource allocation and hospital risk assessment [\u003cspan additionalcitationids=\"CR7\" citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]. As mature decision analysis tools, they can effectively address these issues. Nevertheless, their application in the field of CDI management has not been reported in relevant studies. Based on the aforementioned research gaps, this study innovatively constructs an integrated AHP-FCE model to solve the multi-criteria decision-making problems in CDI management. By establishing a quantitative evaluation system and an intelligent decision support system, this study aims to provide medical institutions with scientific and operable management schemes, which hold important theoretical value and practical significance for improving the efficiency of hospital infection prevention and control and reducing the risk of CDI transmission.\u003c/p\u003e"},{"header":"2 Materials and Methods","content":"\u003cdiv id=\"Sec3\" class=\"Section2\"\u003e\u003ch2\u003e2.1 Expert Selection and Indicator Scoring\u003c/h2\u003e\u003cp\u003eExperts in relevant fields including hospital infection management, public health, clinical medicine, and nursing were selected. The inclusion criteria for experts were: 1. Having worked in the field for 5 years; 2. Engaged in infectious disease-related management work in the past 2 years; 3. Holding an intermediate or higher professional and technical title. The exclusion criteria were: 1. Having worked in the field for less than 5 years; 2. Not engaged in infectious disease management and treatment-related work in the past 2 years; 3. Holding a primary professional and technical title; 4. Unwilling to participate in this study. Experts were invited via email to analyze and judge the initially screened indicators, and conduct quantitative evaluations from the perspectives of importance, representativeness, and feasibility.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec4\" class=\"Section2\"\u003e\u003ch2\u003e2.2 Construction of the Evaluation System\u003c/h2\u003e\u003cp\u003eThe management requirements for Clostridium difficile were identified through literature retrieval, network search, brainstorming, media report cases, guideline and specification requirements, government document requirements, and on-site investigations, and the core elements requiring attention in Clostridium difficile management in medical institutions were determined. From August 1, 2024 to March 31, 2025, through two rounds of the Delphi method, the first-level and second-level indicators of the decision support system for Clostridium difficile management in medical institutions were confirmed. The weights of the first-level and second-level indicators of the decision support system for Clostridium difficile management were calculated again using the expert group decision AHP method. Finally, the FCE was used to process the management status in the decision-making process, thus forming the Clostridium difficile management evaluation system.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec5\" class=\"Section2\"\u003e\u003ch2\u003e2.3 Calculation of Indicator Weights\u003c/h2\u003e\u003cp\u003eExperts scored the relative importance of the listed indicators, and the assignment was carried out using the principle of indicator value sorting and partitioning. The actual indicator data were sorted from low to high, a judgment matrix was constructed, and the indicator weight values were calculated. There were 7 first-level indicators: System Requirements, Special Identification, Material Preparation, Monitoring, Cleaning and Disinfection, Isolation and Treatment, and Training and Education; and 40 second-level indicators, including the soundness of the hospital Clostridium difficile management system, the implementation of first-level quality control for Clostridium difficile prevention and control in departments, and the implementation of second-level quality control and reward and punishment systems for Clostridium difficile in hospitals.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec6\" class=\"Section2\"\u003e\u003ch2\u003e2.4 Statistical Analysis\u003c/h2\u003e\u003cp\u003eThe professional version of yaahp12.12 was used to generate the expert questionnaire for the Clostridium difficile management decision support system. The expert questionnaires were distributed in a targeted manner. After the questionnaires were collected, all data were subject to completeness verification, quality review, and logical error correction by special personnel, then imported into the software. The weight coefficients of each evaluation indicator were calculated through group decision-making, and then the FCE was used to complete the Clostridium difficile management decision evaluation system.\u003c/p\u003e\u003c/div\u003e"},{"header":"3 Results","content":"\u003cdiv id=\"Sec8\" class=\"Section2\"\u003e\u003ch2\u003e3.1 Basic Information\u003c/h2\u003e\u003cp\u003eThe positive coefficients of the two rounds of expert consultation were 91.30% and 100%, the authority coefficients were 0.842 and 0.891, and the coordination coefficients were 0.370 and 0.425. A total of 23 experts were selected for consultation in this study, involving professionals from hospital infection management, clinical doctors, clinical nurses, public health management and other departments of medical institutions. The ratio of male to female experts was 1:1.9, with an average age of (42.26\u0026thinsp;\u0026plusmn;\u0026thinsp;5.79) years. Among them, 18 experts (75.0%) had a bachelor's degree or below, 2 (8.3%) had a master's degree, and 3 (12.5%) had a doctoral degree; 13 experts (54.1%) held intermediate titles, 5 (20.8%) held associate senior titles, and 5 (20.8%) held senior titles; currently, 18 experts (75.0%) are mainly engaged in health management, 2 (8.3%) in disease control work, and 3 (12.5%) in clinical medical work; 5 experts (20.8%) have worked in the profession for 5 years or less, 5 (20.8%) for 5 to 10 years, 5 (20.8%) for 10 to 15 years, 3 (12.5%) for 15 to 20 years, and 5 (20.8%) for more than 20 years; none of the experts have participated in previous studies related to Clostridium difficile management decisions; 19 experts (79.1%) are from tertiary medical institutions, 2 (8.3%) from secondary medical institutions, and 2 (8.3%) from ungraded institutions.\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e\u003ch2\u003e3.2 Clostridium difficile Management Decision Support System\u003c/h2\u003e\u003cp\u003eThe AHP-based model generally consists of three parts: the decision-making layer, the middle layer, and the scheme layer. In this study, relevant indicators were determined through literature review and interviews with experts in fields such as hospital infection, clinical medicine, nursing, and public health. Seven intermediate indicators affecting the Clostridium difficile management decision support system were identified, and then 40 sub-layer indicators were divided.\u003c/p\u003e\u003cdiv id=\"Sec10\" class=\"Section3\"\u003e\u003ch2\u003e3.2.1 Ranking Weights of Elements in the Scheme Layer for the Decision-Making Objective\u003c/h2\u003e\u003cp\u003eThrough the group decision-making method, the arithmetic mean method was adopted for the judgment matrix, and the matrix consistency was 0.0985. The ranking results of the weights of each element included in the model are shown in Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e. The combined consistency of each element in the criterion layer for Clostridium difficile management is shown in Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eRanking Weights of Elements in the Scheme Layer for the Decision-Making Objective\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"6\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eAlternative Scheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRanking\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAlternative Scheme\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c6\"\u003e\u003cp\u003eRanking\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.1 Single-room isolation or cohort isolation of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1610\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.2 Departmental implementation of first-level quality control for Clostridium difficile prevention and control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0122\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.2 Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1076\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.1 Provision of rapid hand sanitizer and gloves at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0099\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.2 Strict grouping and fixation of nursing staff for Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0832\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.3 Hospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0089\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.2 Clostridium difficile screening for high-risk patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0730\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.4 Active screening for colonizing bacteria in key patient groups by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0087\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.1 Implementation of corresponding disinfection levels for reusable instruments based on risk assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0567\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.4 Patients wearing Clostridium difficile identification wristbands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0085\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.3 Isolation orders must be issued within 30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0533\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.5 Diagnostic and therapeutic operations for Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0068\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.4 Cleaning and disinfection of bed units of Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0532\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.8 Training on hand hygiene for medical staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0066\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.3 Daily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0472\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.1 Regular training on Clostridium difficile prevention and control conducted by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0056\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.5 Timely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0305\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.4 Medical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0052\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.4 Precise treatment of Clostridium difficile patients by doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0298\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.9 Rationality of handling related stakeholders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0050\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.6 Laboratory telephone reporting to clinical departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0279\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.7 Strict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0049\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.3 Posting of isolation signs at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0227\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.4 Medical staff in departments familiar with the detection trend of Clostridium difficile in their own departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0042\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5.5 Lifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0223\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.7 Domestic waste of Clostridium difficile patients disposed of as medical waste\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0035\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.1 Regular environmental hygiene monitoring in areas where Clostridium difficile patients are located\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0214\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.3 All staff in clinical departments aware of basic information of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0034\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4.5 Regular emptying and disinfection of wards where Clostridium difficile patients are admitted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0206\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e1.8 Standardized disposal of medical waste from Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0033\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1.1 Soundness of the hospital Clostridium difficile management system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e2.1 Isolation signs affixed to patient medical records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0029\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2.2 Implementation of Clostridium difficile marking in information system test application forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0167\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.6 Handwashing sinks in areas where patients are located dedicated to hand hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0028\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7.6 Notifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0157\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.3 Isolation gowns provided at the patient's bedside and replaced daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0027\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3.5 Diagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0153\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e7.2 Health education on Clostridium difficile prevention and control for patients and their families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0023\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6.3 Regular monitoring of hand hygiene of staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0125\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003e3.2 Covered medical waste bins provided at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0015\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c6\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eCombined Consistency of Each Element in the Criterion Layer for Clostridium difficile Management\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"4\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eCriterion Layer Elements\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCI\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRI (Order)\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 Isolation and Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0404\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.1200 (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 Cleaning and Disinfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.2854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0990\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.1200 (5)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 System Requirements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.1430\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4600 (9)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 Monitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0123\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.5200 (3)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 Special Identification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.0847\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e0.8900 (4)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7 Training and Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0494\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.1128\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.4100 (8)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 Material Preparation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e\u003cp\u003e0.1154\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e\u003cp\u003e1.2600 (6)\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec11\" class=\"Section3\"\u003e\u003ch2\u003e3.2.2 Indicators and Weights of the Clostridium difficile Management Decision Support Evaluation Scale\u003c/h2\u003e\u003cp\u003eThrough the Delphi method, the middle layer of first-level indicators of the Clostridium difficile management decision support evaluation scale was determined, including 7 indicators: System Requirements, Special Identification, Material Preparation, Monitoring, Cleaning and Disinfection, Isolation and Treatment, and Training and Education. The scheme layer of second-level indicators includes 40 indicators such as the soundness of the hospital Clostridium difficile management system and the implementation of first-level quality control for Clostridium difficile prevention and control in departments. The specific importance of each indicator is shown in Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eIndicators and Weights of the Clostridium difficile Management Decision Support Evaluation Scale\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"5\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e\u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eFirst-level Indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSecond-level Indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExplanation of Second-level Indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c5\"\u003e\u003cp\u003eWeight\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1 System Requirements\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1204\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.1 Soundness of the hospital Clostridium difficile management system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe hospital has a Clostridium difficile prevention and control plan\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0204\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.2 Departmental implementation of first-level quality control for Clostridium difficile prevention and control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSOP for Clostridium difficile prevention and control and daily operation records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0122\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.3 Hospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSupervision and assessment records of Clostridium difficile management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0089\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.4 Active screening for colonizing bacteria in key patient groups by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe situation of Clostridium difficile screening for key groups by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0087\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.5 Timely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHandling of 2 or more cases of Clostridium difficile in the same ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0305\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.6 Laboratory telephone reporting to clinical departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eTelephone notification of Clostridium difficile results to clinical departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0279\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.7 Domestic waste of Clostridium difficile patients disposed of as medical waste\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll domestic waste generated by Clostridium difficile patients is managed as medical waste\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0035\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.8 Standardized disposal of medical waste from Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eNo risk of cross-contamination in the management of medical waste generated by Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0033\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e1.9 Rationality of handling related stakeholders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eConsidering the rights of various personnel in Clostridium difficile management\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0050\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2 Special Identification\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0509\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.1 Isolation signs affixed to patient medical records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eContact isolation signs affixed to the cover of medical records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0029\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.2 Implementation of Clostridium difficile marking in information system test application forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSpecial marks for Clostridium difficile patients on test application forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0167\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.3 Posting of isolation signs at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eContact isolation signs at obvious positions of the bed units of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0227\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e2.4 Patients wearing Clostridium difficile identification wristbands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003ePatients wear identification wristbands on their wrists or ankles\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0085\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3 Material Preparation\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0374\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.1 Provision of rapid hand sanitizer and gloves at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eSpecial gloves and hand sanitizer prepared for each bed unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0099\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.2 Covered medical waste bins provided at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAt least one covered medical waste bin provided in each patient's bed unit\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0015\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.3 Isolation gowns provided at the patient's bedside and replaced daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDisposable isolation gowns or visitor gowns provided at the bedside, replaced daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0027\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.4 Medical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eIsolation gowns required for any operations involving physical contact\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0052\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.5 Diagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDiagnostic and therapeutic supplies and cleaning tools are used exclusively by one patient and disinfected in a timely manner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0153\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e3.6 Handwashing sinks in areas where patients are located dedicated to hand hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHandwashing sinks for medical staff's hand hygiene around Clostridium difficile patients are only used for handwashing\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0028\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4 Cleaning and Disinfection\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.2854\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.1 Implementation of corresponding disinfection levels for reusable instruments based on risk assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eReusable instruments are disinfected according to low, medium, and high risks\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0567\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.2 Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eCleaning staff engaged in the cleaning and disinfection of patient bed units need professional training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.1076\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.3 Daily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe surface of objects in the bed units of Clostridium difficile patients is cleaned and disinfected no less than twice a day\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0472\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.4 Cleaning and disinfection of bed units of Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe cleaning and disinfection of bed units of Clostridium difficile patients are completed after those of other patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0532\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e4.5 Regular emptying and disinfection of wards where Clostridium difficile patients are admitted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll hospital beds in wards admitting Clostridium difficile patients are thoroughly disinfected regularly\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0206\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5 Isolation and Treatment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.3497\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.1 Single-room isolation or cohort isolation of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eClostridium difficile patients live alone or all Clostridium difficile patients are concentrated in the same ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.1610\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.2 Strict grouping and fixation of nursing staff for Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedical and nursing staff fixed to provide care for Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0832\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.3 Isolation orders must be issued within 30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAfter the department receives the Clostridium difficile report, the isolation order is implemented within 30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0533\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.4 Precise treatment of Clostridium difficile patients by doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eStandardized medication for the treatment of Clostridium difficile patients by doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0298\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e5.5 Lifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eDiarrhea symptoms disappear, and two Clostridium difficile tests are negative\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0223\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6 Monitoring\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.1069\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.1 Regular environmental hygiene monitoring in areas where Clostridium difficile patients are located\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe ward conducts surface monitoring of areas where Clostridium difficile patients have stayed\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0214\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.2 Clostridium difficile screening for high-risk patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eThe ward conducts Clostridium difficile screening for patients with diarrhea and unformed stools\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0730\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e6.3 Regular monitoring of hand hygiene of staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eHand hygiene monitoring is conducted quarterly in wards where Clostridium difficile patients are located\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0125\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7 Training and Education\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e\u003cp\u003e0.0494\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.1 Regular training on Clostridium difficile prevention and control conducted by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll staff in the department receive training on Clostridium difficile prevention and control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0056\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.2 Health education on Clostridium difficile prevention and control for patients and their families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eRecords of training received by Clostridium difficile patients and their families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0023\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.3 All staff in clinical departments aware of basic information of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedical staff in the ward are familiar with the bed numbers of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0034\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.4 Medical staff in departments familiar with the detection trend of Clostridium difficile in their own departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedical staff in the ward are familiar with the detection trend of Clostridium difficile in their own ward\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0042\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.5 Diagnostic and therapeutic operations for Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eMedical staff place Clostridium difficile patients last during diagnostic and therapeutic activities\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0068\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.6 Notifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eBefore transferring Clostridium difficile patients who have not been lifted from isolation, the receiving department must be notified by telephone\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0157\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.7 Strict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eExternal personnel and consulting doctors implement relevant prevention and control measures when contacting Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0049\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u0026nbsp;\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003e7.8 Training on hand hygiene for medical staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c4\"\u003e\u003cp\u003eAll medical staff in the ward receive hand hygiene training\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e\u003cp\u003e0.0066\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003cdiv id=\"Sec12\" class=\"Section3\"\u003e\u003ch2\u003e3.2.3 Construction of the Clostridium difficile Management Decision Evaluation Scale by Combining AHP and FCE\u003c/h2\u003e\u003cp\u003eAfter determining the weight coefficients of each evaluation indicator using AHP, the evaluation scale was directly generated. The Clostridium difficile management decision evaluation scale includes the evaluator's name, unit, and evaluation object. This scale contains 40 evaluation indicators. According to the explanation of the evaluation indicators, the evaluation grade (Excellent, Good, Fair, Poor) is selected to obtain the specific evaluation score. The specific details are shown in Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e.\u003c/p\u003e\u003cp\u003e\u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e\u003ccaption language=\"En\"\u003e\u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e\u003cdiv class=\"CaptionContent\"\u003e\u003cp\u003eClostridium difficile Management Decision Evaluation Scale Based on AHP and FCE\u003c/p\u003e\u003c/div\u003e\u003c/caption\u003e\u003ccolgroup cols=\"3\"\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e\u003cthead\u003e\u003ctr\u003e\u003cth align=\"left\" colname=\"c1\"\u003e\u003cp\u003eNo.\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c2\"\u003e\u003cp\u003eEvaluation Indicators\u003c/p\u003e\u003c/th\u003e\u003cth align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExplanation of Evaluation Indicators\u003c/p\u003e\u003c/th\u003e\u003c/tr\u003e\u003c/thead\u003e\u003ctbody\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e1\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSoundness of the hospital Clostridium difficile management system\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe hospital has a Clostridium difficile prevention and control plan\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e2\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDepartmental implementation of first-level quality control for Clostridium difficile prevention and control\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSOP for Clostridium difficile prevention and control and daily operation records\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e3\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHospital implementation of second-level quality control and reward and punishment systems for Clostridium difficile\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSupervision and assessment records of Clostridium difficile management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e4\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eActive screening for colonizing bacteria in key patient groups by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe situation of Clostridium difficile screening for key groups by departments\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e5\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTimely reporting of suspected outbreaks of Clostridium difficile healthcare-associated infections\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHandling of 2 or more cases of Clostridium difficile in the same ward\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e6\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLaboratory telephone reporting to clinical departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eTelephone notification of Clostridium difficile results to clinical departments\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e7\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDomestic waste of Clostridium difficile patients disposed of as medical waste\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll domestic waste generated by Clostridium difficile patients is managed as medical waste\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e8\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStandardized disposal of medical waste from Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eNo risk of cross-contamination in the management of medical waste generated by Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e9\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRationality of handling related stakeholders\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eConsidering the rights of various personnel in Clostridium difficile management\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e10\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIsolation signs affixed to patient medical records\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContact isolation signs affixed to the cover of medical records\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e11\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImplementation of Clostridium difficile marking in information system test application forms\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpecial marks for Clostridium difficile patients on test application forms\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e12\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePosting of isolation signs at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eContact isolation signs at obvious positions of the bed units of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e13\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePatients wearing Clostridium difficile identification wristbands\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003ePatients wear identification wristbands on their wrists or ankles\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e14\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eProvision of rapid hand sanitizer and gloves at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eSpecial gloves and hand sanitizer prepared for each bed unit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e15\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCovered medical waste bins provided at the patient's bedside\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAt least one covered medical waste bin provided in each patient's bed unit\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e16\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIsolation gowns provided at the patient's bedside and replaced daily\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDisposable isolation gowns or visitor gowns provided at the bedside, replaced daily\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e17\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical staff required to wear isolation gowns during physical contact in diagnostic and therapeutic operations\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eIsolation gowns required for any operations involving physical contact\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e18\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiagnostic and therapeutic supplies and cleaning tools dedicated to individuals and disinfected in a timely manner\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiagnostic and therapeutic supplies and cleaning tools are used exclusively by one patient and disinfected in a timely manner\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e19\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHandwashing sinks in areas where patients are located dedicated to hand hygiene\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHandwashing sinks for medical staff's hand hygiene around Clostridium difficile patients are only used for handwashing\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e20\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eImplementation of corresponding disinfection levels for reusable instruments based on risk assessment\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eReusable instruments are disinfected according to low, medium, and high risks\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e21\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSpecialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eCleaning staff engaged in the cleaning and disinfection of patient bed units need professional training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e22\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDaily cleaning and disinfection of items, environment, and medical devices around patients at least twice a day (with immediate disinfection in case of contamination)\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe surface of objects in the bed units of Clostridium difficile patients is cleaned and disinfected no less than twice a day\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e23\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eCleaning and disinfection of bed units of Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe cleaning and disinfection of bed units of Clostridium difficile patients are completed after those of other patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e24\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegular emptying and disinfection of wards where Clostridium difficile patients are admitted\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll hospital beds in wards admitting Clostridium difficile patients are thoroughly disinfected regularly\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e25\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eSingle-room isolation or cohort isolation of patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eClostridium difficile patients live alone or all Clostridium difficile patients are concentrated in the same ward\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e26\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrict grouping and fixation of nursing staff for Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical and nursing staff fixed to provide care for Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e27\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eIsolation orders must be issued within 30 minutes\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAfter the department receives the Clostridium difficile report, the isolation order is implemented within 30 minutes\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e28\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003ePrecise treatment of Clostridium difficile patients by doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eStandardized medication for the treatment of Clostridium difficile patients by doctors\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e29\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eLifting of isolation orders when infection symptoms disappear and two targeted specimens are negative at 24-hour intervals\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eDiarrhea symptoms disappear, and two Clostridium difficile tests are negative\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e30\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegular environmental hygiene monitoring in areas where Clostridium difficile patients are located\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe ward conducts surface monitoring of areas where Clostridium difficile patients have stayed\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e31\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eClostridium difficile screening for high-risk patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eThe ward conducts Clostridium difficile screening for patients with diarrhea and unformed stools\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e32\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegular monitoring of hand hygiene of staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eHand hygiene monitoring is conducted quarterly in wards where Clostridium difficile patients are located\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e33\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eRegular training on Clostridium difficile prevention and control conducted by departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll staff in the department receive training on Clostridium difficile prevention and control\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e34\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eHealth education on Clostridium difficile prevention and control for patients and their families\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eRecords of training received by Clostridium difficile patients and their families\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e35\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eAll staff in clinical departments aware of basic information of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical staff in the ward are familiar with the bed numbers of Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e36\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eMedical staff in departments familiar with the detection trend of Clostridium difficile in their own departments\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical staff in the ward are familiar with the detection trend of Clostridium difficile in their own ward\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e37\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eDiagnostic and therapeutic operations for Clostridium difficile patients to be performed last\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eMedical staff place Clostridium difficile patients last during diagnostic and therapeutic activities\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e38\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eNotifying the receiving department to prepare for Clostridium difficile prevention and control before transferring patients\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eBefore transferring Clostridium difficile patients who have not been lifted from isolation, the receiving department must be notified by telephone\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e39\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eStrict implementation of Clostridium difficile patient prevention and control systems by external personnel and consulting doctors\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eExternal personnel and consulting doctors implement relevant prevention and control measures when contacting Clostridium difficile patients\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003ctr\u003e\u003ctd align=\"left\" colname=\"c1\"\u003e\u003cp\u003e40\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c2\"\u003e\u003cp\u003eTraining on hand hygiene for medical staff\u003c/p\u003e\u003c/td\u003e\u003ctd align=\"left\" colname=\"c3\"\u003e\u003cp\u003eAll medical staff in the ward receive hand hygiene training\u003c/p\u003e\u003c/td\u003e\u003c/tr\u003e\u003c/tbody\u003e\u003c/colgroup\u003e\u003c/table\u003e\u003c/div\u003e\u003c/p\u003e\u003c/div\u003e\u003c/div\u003e"},{"header":"4 Discussion","content":"\u003cp\u003eThe prevention and control of healthcare-associated infections caused by Clostridium difficile have always attracted great attention. Healthcare-associated infection prevention and control involve many management measures, including correct contact precautions, handwashing with soap and water, use of gloves, thorough cleaning of medical equipment and the environment around patients, and rational use of antibiotics [\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]. However, the implementation and execution of some prevention and control measures are restricted by the specific scenarios of medical institutions. It is particularly important to implement prevention and control measures under scientific guidance and consider the priority of various measures. The combination of AHP and FCE can effectively solve this problem.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.1 Significant Differences in the Importance of Each Element in the Scheme Layer in the Clostridium difficile Management Decision Evaluation\u003c/b\u003e\u003c/p\u003e\u003cp\u003eIn CDI management, the indicator weights of the decision support system reflect the relative importance of various measures in prevention and control. Isolation and Treatment (0.3497) and Cleaning and Disinfection (0.2854) are the two core measures, while the weights of System Requirements, Training and Education, Special Identification, Monitoring, and Material Preparation decrease in sequence.Isolation and Treatment have the highest weight in CDI management, indicating their core position in prevention and control. CDI is highly contagious, and spores in patients' feces can survive in the environment for a long time. Therefore, timely isolation of infected patients is the key to blocking the transmission chain [\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]. In addition, early diagnosis and standardized treatment can effectively reduce the severity of the disease and the recurrence rate [\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e]. Studies have shown that delayed treatment is significantly associated with patient mortality [\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e]; thus, the high weight of Isolation and Treatment reflects its priority in clinical practice.Cleaning and Disinfection is the second most important measure for Clostridium difficile prevention and control. Clostridium difficile spores are highly resistant to conventional disinfectants, so high-efficiency disinfectants such as chlorine-containing disinfectants or hydrogen peroxide must be used [\u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e]. Consistent with previous results, inadequate environmental cleaning is one of the main risk factors for the transmission of Clostridium difficile in hospitals [\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]. In addition, the cleaning and disinfection of high-frequency contact surfaces are particularly important, as these areas may become intermediaries for spore transmission [\u003cspan citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e]. The high weight of Cleaning and Disinfection highlights its key role in blocking environmental transmission.System Requirements include the formulation and implementation of hospital infection control policies, such as hand hygiene standards and antibiotic management strategies. The abuse of antibiotics is one of the main incentives for CDI, so antibiotic management is an important part of prevention and control [\u003cspan citationid=\"CR16\" class=\"CitationRef\"\u003e16\u003c/span\u003e]. Studies have shown that the implementation of strict antibiotic management policies can significantly reduce the CDI rate [\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e]. In addition, the implementation of hand hygiene systems is also a key part of prevention and control. Although Clostridium difficile spores are not sensitive to alcohol-based hand sanitizers, handwashing with soap and water can effectively remove spores [\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e].Training and Education are important means to improve the prevention and control awareness of medical staff and patients. Consistent with previous research results, the lack of knowledge of CDI prevention and control among medical staff is one of the main reasons for the inadequate implementation of prevention and control measures [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e]. Through regular training and education, the compliance of medical staff with measures such as isolation, cleaning and disinfection, and hand hygiene can be improved [\u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. In addition, educating patients and their families also helps to reduce the risk of healthcare-associated transmission.Special Identification is used to remind medical staff and visitors of infection risks. Studies have shown that a clear identification system can improve the compliance of medical staff with infection prevention and control measures [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e]. However, the weight of Special Identification is relatively low, which may be because its role is more auxiliary rather than a direct intervention measure.Monitoring includes the tracking and analysis of CDI rate, recurrence rate, and antibiotic use. Monitoring data can provide a scientific basis for hospital infection control and help identify high-risk areas and populations [\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. However, the weight of Monitoring is relatively low, which may be because its role is more about post-evaluation rather than direct intervention.Material Preparation includes the reserve of disinfectants, protective equipment, and detection reagents. Although Material Preparation is the basis for prevention and control, its weight is the lowest, which may be because the supply of materials is relatively stable in most medical institutions, and its impact is more indirect.The indicator weights of the Clostridium difficile management decision support system reflect the relative importance of various measures in prevention and control. Isolation and Treatment and Cleaning and Disinfection are the two core measures, while the weights of System Requirements, Training and Education, Special Identification, Monitoring, and Material Preparation decrease in sequence. This weight distribution provides a scientific basis for hospital infection control and helps optimize resource allocation and prevention and control strategies.\u003c/p\u003e\u003cp\u003e\u003cb\u003e4.2 Differences in the Importance of Each Element in the Middle Layer and Criterion Layer for the Clostridium difficile Management Decision Support System\u003c/b\u003e\u003c/p\u003e\u003cp\u003eThe weight ranking of the second-level indicators of the decision support system in CDI management reflects the relative importance of different intervention measures in infection control.Isolation is the core measure to block the transmission of Clostridium difficile. Clostridium difficile is mainly transmitted through contact, and its spores can survive in the environment for a long time. Isolating patients can significantly reduce the risk of cross-infection. The guidelines of the Centers for Disease Control and Prevention (CDC) emphasize that confirmed or suspected CDI patients should be given priority for single-room isolation; if resources are limited, cohort isolation in the same room is recommended, and dedicated toilets should be equipped [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. Relevant studies have shown that timely isolation can reduce the incidence of CDI by more than 50% [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]; thus, the high weight of this measure reflects its primary position in blocking the infection chain.\u003c/p\u003e\u003cp\u003eThe fixed grouping of nursing staff aims to reduce cross-contamination caused by personnel movement. Dubberke et al. [\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e] pointed out that nursing staff may carry spores through their hands or work clothes, and fixed grouping can reduce the risk of transmission. A prospective study showed that after the implementation of group nursing, the transmission rate during CDI outbreaks decreased by 35% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]. In addition, fixed teams help improve operational standardization, thereby strengthening the prevention and control effect.Inadequate disinfection of medical devices may become an important medium for the transmission of Clostridium difficile. Rutala et al. [\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e] proposed that disinfection should be carried out according to the risk classification of instruments contacting patients' mucous membranes or sterile sites. The guidelines of the American Society for Gastrointestinal Endoscopy emphasize that most CDI outbreaks related to endoscopes are associated with defects in the disinfection process, and strict implementation of hierarchical disinfection can reduce such risks [\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]. The weight of this measure reflects the key role of instrument management in infection control.The cleaning order affects the effect of environmental disinfection. Carling et al. [\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e] recommended following the principle of \"from clean to dirty\", that is, cleaning low-contamination areas first and handling high-risk areas last to avoid the spread of contamination. A simulation study showed that adjusting the cleaning order can reduce the spore load in the environment by 40% [\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. This measure improves the overall cleaning efficiency by optimizing the workflow, but its weight is relatively low, which may be due to the large differences in compliance with the order in actual operations.Frequent environmental disinfection can reduce spore residues. Faires et al. [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e] found that daily cleaning of the environment around patients with chlorine-containing disinfectants (concentration\u0026thinsp;\u0026gt;\u0026thinsp;1000 pp) can reduce the incidence of CDI by 30%. However, the weight of this measure is only fifth, which may be because some institutions are limited by manpower or costs and cannot fully implement it. It is worth noting that advocating immediate handling of contamination can further optimize environmental management [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e].This study found that the weight of hand hygiene is not among the top five. Although hand hygiene is the cornerstone of CDI prevention and control, it did not rank in the top five. This may be because hand hygiene is already a common intervention measure in medical institutions, and its implementation rate has reached a high level, so its importance in CDI prevention and control is relatively weakened.Barriers to the implementation of prevention and control measures: Single-room isolation, a high-weight measure, may be limited by medical resources, so resource allocation needs to be optimized in combination with cost-benefit analysis [\u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e].Impact of emerging technologies: The application of automated disinfection equipment may change the weight distribution of traditional cleaning and disinfection [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Future studies can further verify the synergistic effect of various measures in actual scenarios and explore dynamic weight models to adapt to the differences in resource allocation of different medical institutions.\u003c/p\u003e\u003cdiv id=\"Sec14\" class=\"Section2\"\u003e\u003ch2\u003e4.3 Precautions for the Use of the Clostridium difficile Management Decision Support Evaluation System\u003c/h2\u003e\u003cp\u003eThe application of the CDI management decision support evaluation system needs to be combined with clinical practice and evidence-based medical evidence. The following aspects require attention:First, standardize the detection process and result interpretation. Strict implementation of the stepwise detection strategy: The system should support the \"two-step method\" of glutamate dehydrogenase detection combined with toxin detection or nucleic acid amplification technology (NAAT) to reduce the false positive rate. Studies have shown that relying solely on NAAT may overestimate the incidence of CDI because it cannot distinguish colonization from infection [\u003cspan citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e]. Strict control of sample quality: Only water samples or watery stool samples are suitable for detection, and formed stool samples should be marked as \"not applicable\" by the system to avoid false negative results [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]. Comprehensive judgment combined with clinical background: Detection results need to be combined with patient symptoms, antibiotic use history, and laboratory indicators to avoid over-treatment of asymptomatic colonization [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e].Second, dynamic adjustment of individualized treatment plans. Medication based on severity classification: Oral vancomycin or fidaxomicin is recommended for mild to moderate CDI, and intravenous metronidazole should be combined for severe or fulminant cases. The system should prompt that the failure rate of metronidazole monotherapy is high (20%\u0026ndash;30%), and it is not recommended for severe patients [\u003cspan citationid=\"CR36\" class=\"CitationRef\"\u003e36\u003c/span\u003e]. Precise management of recurrent CDI: For the first recurrence, the course of vancomycin can be extended; for the second and subsequent recurrences, fidaxomicin or fecal microbiota transplantation (FMT) is recommended. The system should integrate the patient's immune status to assess the risk of FMT [\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. Synchronous management of antibacterial drugs: When initiating CDI treatment, the system should force a prompt to discontinue high-risk antibiotics and recommend narrow-spectrum alternative schemes to reduce intestinal flora disturbance [\u003cspan citationid=\"CR38\" class=\"CitationRef\"\u003e38\u003c/span\u003e].Third, implementation and optimization of infection control measures. Priority of isolation measures: Single-room isolation of patients or cohort isolation (centralized care) is the core of blocking transmission, with the highest weight (0.1363). Relevant studies have shown that delaying isolation for 24 hours can increase the transmission risk by 3 times [\u003cspan citationid=\"CR39\" class=\"CitationRef\"\u003e39\u003c/span\u003e]. Standardized operation of environmental disinfection: The system should prompt the use of chlorine-containing disinfectants to clean the environment around patients at least twice a day, and bed unit disinfection should be placed in the last step to avoid contamination spread [\u003cspan citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e]. Monitoring of nursing staff behavior: The system can integrate hand hygiene compliance monitoring data and fix nursing staff groups to reduce cross-infection. Relevant studies have shown that increasing hand hygiene compliance to \u0026gt;\u0026thinsp;90% can reduce the incidence of CDI by 40% [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e].Fourth, data timeliness and multidisciplinary collaboration. Dynamic update mechanism of guidelines: The system should integrate the latest evidence-based evidence in real time to avoid decisions based on outdated strategies. Integration of multidisciplinary data: It is necessary to include surgical consultation indications (colon perforation), nutritional support schemes (priority to enteral nutrition), and microbiological data (highly virulent strain RT027) to provide interdisciplinary decision support [\u003cspan citationid=\"CR41\" class=\"CitationRef\"\u003e41\u003c/span\u003e].Fifth, patient risk assessment and early warning. Identification of high-risk groups: The system should automatically mark elderly patients (\u0026ge;\u0026thinsp;65 years old), patients with long-term use of proton pump inhibitors (PPI) or immunosuppressants, and issue early warnings of CDI risk. Previous studies have also shown that PPI use can increase the risk of CDI [\u003cspan citationid=\"CR42\" class=\"CitationRef\"\u003e42\u003c/span\u003e].Sixth, targeted solutions to implementation barriers. Institutions with limited resources can adopt \"risk-stratified isolation\" to give priority to isolating severe or high-transmission-risk patients [\u003cspan citationid=\"CR43\" class=\"CitationRef\"\u003e43\u003c/span\u003e]. Implement continuous quality improvement: Optimize processes through system feedback data and analyze the correlation between environmental disinfection compliance and CDI incidence [\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e].This study successfully constructed a Clostridium difficile management decision support system based on AHP and FCE. The design and application of the system demonstrate its effectiveness and practicality in dealing with complex medical decision-making problems and show its potential in improving the efficiency of CDI management. Despite the positive results, the study still has some limitations: the accuracy of the model is highly dependent on the quality of expert data, and the current indicator system may need to be updated with changes in medical practice. Future studies can consider introducing more real-time data and advanced data analysis technologies to improve the prediction ability and adaptability of the system. This study provides a powerful decision-making tool for CDI management, which can evaluate the current status of CDI management in medical institutions at all levels and lay a foundation for the research and application of other types of healthcare-associated infections in the future. With the continuous progress of technology and the improvement of methods, it is expected that this system will play a greater role in future medical management practice.\u003c/p\u003e\u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eFunding\u003c/h2\u003e\u003cp\u003eThis study was supported by the Chengdu Medical Research Funding Project (Project No.: 2022402), the Sichuan Preventive Medicine Association Funding Project (Project No.: SYYXHPT202407), the Sichuan Science and Technology Department Funding Project (Project No.: 21RX0084), and the Chengdu Science and Technology Bureau Funding Project (Project No.: 2023-RK00-00160-ZF).\u003c/p\u003e\u003ch2\u003eAuthor Contribution\u003c/h2\u003e\u003cp\u003eZhou Gui (Corresponding Author)\u0026sup1;: Conceived and designed the overall research framework; initiated the study on Clostridium difficile management decision support system; led the expert consultation process (including expert selection, indicator design, and questionnaire distribution); supervised data analysis and model construction (AHP and FCE); drafted the manuscript and revised it critically for important intellectual content; coordinated cross-institutional collaboration and finalized the submission version.Fu Youyun\u0026sup1;: Participated in the construction of the evaluation system; conducted systematic literature retrieval and collation (covering guidelines, government documents, and previous studies on Clostridium difficile management); assisted in designing primary and secondary indicators based on literature review and on-site investigations; verified the feasibility of indicators and contributed to the \"Materials and Methods\" section.Feng Lei\u0026sup2;: Specialized in training and education-related content; designed training-related indicators in the evaluation system (e.g., specialized training for cleaning staff, regular training for medical staff); provided professional insights on the design of training and education modules; analyzed the weight results of training-related indicators and supplemented discussion on their practical application in the \"Discussion\" section.Liu Jing\u0026sup3;: Contributed to expert consultation and data validation; invited and coordinated experts from hospital infection management field (especially from Southwest Medical University Affiliated Hospital); participated in two rounds of Delphi method consultation, collated expert feedback, and verified the rationality of indicator weights; assisted in analyzing the consistency of expert opinions and summarized the basic information of experts in the \"Results\" section.Zhong Jing⁴: Focused on material preparation and cleaning/disinfection-related indicators; provided professional perspectives on medical equipment disinfection (e.g., risk-based disinfection of reusable instruments) based on work experience in medical equipment department; verified the operability of material preparation indicators (e.g., provision of protective equipment at patient bedsides); supplemented literature on medical device disinfection standards to support the discussion.Ma Fujun⁵: Participated in monitoring and system requirements-related research; designed monitoring indicators (e.g., high-risk patient screening, environmental hygiene monitoring); analyzed the weight results of monitoring and system requirements modules; provided practical suggestions on the application of the decision support system in different levels of medical institutions (based on work experience in Ganzhou Third People's Hospital); revised the manuscript to enhance its clinical applicability.\u003c/p\u003e\u003ch2\u003eAcknowledgments\u003c/h2\u003e\u003cp\u003ehe authors would like to express their sincere gratitude to Peng Ling from the Department of Hospital Infection Control of Chengdu No.2 People's Hospital, Zhou Zhufeng (Vice President of the University Hospital of Southwest Jiaotong University), Liu Ji from the Department of Hospital Infection Control of Yunnan No.3 People's Hospital, Zhang Zhanlin from the Department of Hospital Infection Control of Linxia Prefecture People's Hospital of Gansu Province, and other relevant individuals for their valuable support in the questionnaire survey during the research process. Their assistance has been instrumental in the smooth progress of this study.\u003c/p\u003e\u003ch2\u003eData Availability\u003c/h2\u003e\u003cp\u003eThis study has generated and used research data throughout the research process.Data GenerationExpert Consultation Data: From August 1, 2024 to March 31, 2025, two rounds of Delphi method consultations were conducted with 23 experts. Data such as expert demographic information (gender, age, education background, professional title, work experience, affiliated institution), and scoring results on the importance, representativeness, and feasibility of evaluation indicators were collected.Indicator Weight Data: Based on expert scoring, the yaahp 12.12 software was used to construct a judgment matrix, and the weight data of 7 first-level indicators and 40 second-level indicators in the Clostridium difficile management decision support system were calculated.Evaluation Scale Data: Combined with AHP and FCE, an evaluation scale containing 40 indicators was constructed, and the data framework for evaluating the management status through four grades (Excellent, Good, Fair, Poor) was formed.Data UsageStatistical Analysis: The collected expert consultation data and indicator scoring data were verified for completeness, reviewed for quality, and corrected for logical errors, then imported into the software for group decision-making calculation to determine the weight coefficient of each indicator.System Construction: The weight data and evaluation criteria data were used to build the Clostridium difficile management decision support and evaluation system, providing a quantitative basis for subsequent management status evaluation and intervention strategy formulation.Result Verification: The consistency of the judgment matrix (consistency ratio 0.0985) and the coordination coefficient of expert opinions (0.370, 0.425) were verified using the generated data to ensure the scientificity and reliability of the research results.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eMartin, J. 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Control\u003c/em\u003e. \u003cb\u003e13\u003c/b\u003e (1), 110. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://doi.org/10.1186/s13756-024-01364-x\u003c/span\u003e\u003cspan address=\"10.1186/s13756-024-01364-x\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e (2024).\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Clostridium difficile, Analytic Hierarchy Process, Fuzzy Comprehensive Evaluation, Decision Support System, Evaluation","lastPublishedDoi":"10.21203/rs.3.rs-8061011/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-8061011/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eObjective\u003c/h2\u003e\u003cp\u003eTo master the current status of Clostridium difficile management in medical institutions and provide a scientific basis for establishing intervention strategies by constructing a decision-making support and evaluation system for Clostridium difficile management.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e\u003cp\u003eFrom August 1, 2024 to March 31, 2025, multiple research methods including literature review, expert consultation, Analytic Hierarchy Process (AHP), and Fuzzy Comprehensive Evaluation (FCE) were employed.All research methods adhere to the expert method principle, and the professional version of yaahp 12.12 was used as the analysis software. All research protocols have been approved by the Ethics Committee of Chengdu Fifth People's Hospital. Informed consent forms have been obtained from all research subjects themselves[Ethics Approval No.: Lunshen 2023-016 (Sci.)-01].\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e\u003cp\u003eThe weights of first-level indicators in descending order were: Isolation and Treatment (0.3215), Cleaning and Disinfection (0.2466), System Requirements (0.1437), Training and Education (0.0979), Special Identification (0.0789), Monitoring (0.0696), and Material Preparation (0.0418). The top 5 second-level indicators by weight were: Single-room isolation or cohort isolation of patients (0.1610), Specialized training for cleaning staff responsible for bed unit environmental disinfection (with qualification required before taking office) (0.1076), Strict grouping and fixation of nursing staff for Clostridium difficile patients (0.0832), Clostridium difficile screening for high-risk patients (0.0730), and Implementation of corresponding disinfection levels for reusable instruments based on risk assessment (0.0567).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e\u003cp\u003eThis decision-making support system enables hospital administrators to understand the status of Clostridium difficile management, contributes to optimizing resource allocation and establishing dynamic intervention measures, and is worthy of promotion and application.\u003c/p\u003e","manuscriptTitle":"The Construction of a Decision-Making Evaluation System for Clostridium difficile Management Based on AHP and FCE","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-12-03 18:57:15","doi":"10.21203/rs.3.rs-8061011/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"9183c9fe-0ece-4b3c-892c-f9d9dadbe9c4","owner":[],"postedDate":"December 3rd, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":58964724,"name":"Health sciences/Diseases"},{"id":58964725,"name":"Health sciences/Health care"},{"id":58964726,"name":"Health sciences/Medical research"},{"id":58964727,"name":"Health sciences/Risk factors"}],"tags":[],"updatedAt":"2026-01-16T13:23:59+00:00","versionOfRecord":[],"versionCreatedAt":"2025-12-03 18:57:15","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-8061011","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-8061011","identity":"rs-8061011","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}