ADVANCEMENT OF THE SCIENCE
December 21, 2020. Search strategies were adjusted for each platform to account for variations in syntax. No date restrictions were applied, and the language was restricted to English. Search results were uploaded into EndNo- teX8 Desktop reference management soft- ware. Duplicate references were removed using its de-duplication functionality. The EndNote library was uploaded into Distill- erSR systematic review software. Screening for eligibility of both title and abstract (level 1 screening) and full text (level 2 screening) was conducted by two of the authors, working independently. Training was provided and interrater reliability scoring was used to ensure consistency. Level 1 screening was conducted using the following questions: • Does the article discuss C. dicile ? • Is the article about contamination, expo- sure, or transmission in the household environment? If the reviewers agreed that the answer to either question was “no,” the article was excluded. Discrepancies between the review- ers were resolved by consensus. If reviewers agreed that the answer to both questions was “yes” or “unclear,” the article was moved into level 2 screening. Full text articles were acquired through University of Guelph library resources and uploaded into Distill- erSR to complete level 2 screening. Level 2 screening questions were evaluated independently by two reviewers using the fol- lowing questions: • Is the full text available in English? • Does the article describe contamination, transmission, or exposure of C. dicile in the household environment? If both reviewers answered “no” for either question, the article was excluded. Discrep- ancies between the reviewers were resolved by consensus. Figure 1 contains a decision flowchart outlining the inclusion and exclu- sion process. A data extraction form was created in Dis- tillerSR. Changes from the protocol were made to the data extraction form to provide additional options to characterize studies. Any conflicts were resolved through consen- sus. Data items extracted from the studies included characteristics, publication type, population studied, study design, study purpose, and study outcome. A short sum-
TABLE 1
Characteristics of Studies Identified in Scoping Review Process
Study Characteristic
# (%)
Study Characteristic
# (%)
Source ( N = 39) Journal
Population ( n = 19) * Environment
34 (87.2)
6 (31.6) 5 (26.3) 3 (15.7)
Editorial
2 (5.1) 1 (2.6) 1 (2.6) 1 (2.6) 1 (5.3) 1 (5.3) 1 (5.3) 1 (5.3) 1 (5.3)
Humans
Fact sheet
Environment, humans, and animals
Government report
Humans and animals
2 (10.5)
Textbook excerpt
Animals and environment Humans and environment
1 (5.3) 1 (5.3) 1 (5.3)
Year published ( n = 19) 1981
Animals
1983 2001 2010 2012 2013 2014 2016 2017 2018 2019 2020
Design ( n = 19) Prevalence
9 (47.4) 3 (15.7) 2 (10.5) 2 (10.5)
Case-control
Case series
2 (10.5)
Cross-sectional
1 (5.3)
Incidence
1 (5.3) 1 (5.3)
2 (10.5) 3 (15.7) 2 (10.5)
Case-control and quasi- experimental
Other (simulation)
1 (5.3)
1 (5.3)
Randomized controlled
0 (0) 0 (0)
3 (15.7)
Cohort
Location ( n = 19) U.S.
Results Short summaries of the included studies are provided, organized by study design (in order of frequency) and presented in the order of the population studied (humans, animals, environment, or combinations of these populations). Prevalence Studies A Japanese prevalence study published in 2001 involved the enrollment of 1,234 indi- viduals from seven groups: three classes of university students ( n = 234), workers at two hospitals ( n = 284), employees of a company ( n = 89), and self-defense force personnel ( n = 627) (Kato et al., 2001). Stool samples were Note . At the time of the literature review, the Berinstein et al. (2021) reference was prepublished online in 2020 prior to formal publication in 2021. As such, that reference is listed in this table as being published in 2020. *Cases or household contacts of a confirmed case were the specific subject of the studies with human populations. Studies of animals assessed domestic pets. Studies of the environment included surfaces as well as food in the household.
10 (52.6) 3 (15.8) 2 (10.5)
Canada
UK
Slovenia
2 (10.5)
Germany
1 (5.3) 1 (5.3)
Japan
mary of each study was also extracted by one author, which was not described in the protocol. Study design was determined based on the description of how the study was con- ducted (i.e., methodology, purpose of study, enrollment of subjects) rather than the decla- ration of study authors if there was inconsis- tency in declaration and methodology. Table 1 contains a description of the characteristics of the studies identified and included in this scoping review. Notably, there were no exper- imental studies identified. The data extracted from each study were exported from DistillerSRinto an Excel 2011 spreadsheet. Descriptive statistics and graphs were then generated.
10
%74<5. • <5+.9
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