Clostridioides difficile infection (CDI) is a leading cause of nosocomial infections, particularly in immunocompromised individuals. Evidence suggests that opioid use may increase the risk of CDI in hospitalized patients. This systematic review and meta-analysis aims to assess the association between opioid use and CDI among hospitalized patients. A comprehensive literature search was conducted from inception to January 2024 across PubMed/MEDLINE, Web of Science, and the Cochrane Library. The search was supplemented by hand-searching reference lists of included articles. Observational studies comparing adult opioid users with nonusers in a hospital setting were included. The meta-analysis employed a restricted maximum likelihoodrandom-effects model using R Statistical Software, version 4.3.2. From 1,521 articles initially retrieved, 4 met the inclusion criteria, comprising 119,145 patients. Of these, 42,794 were opioid users, and 76,351 were nonusers. There were 13,399 cases of CDI among opioid users, compared with 13,184 among nonusers. The meta-analysis revealed an odds ratio of 1.98 (95% confidence interval: 1.54-2.56), indicating a significantly higher risk of CDI in opioid users. The findings underscore the need for further research to explore the impact of opioid use on the severity of CDI.

Health care-associated infections (HAIs) contribute to patient morbidity and mortality. Hand hygiene is essential for preventing HAIs, but training can fail to transfer to clinical practice. Experiential learning through virtual reality (VR) may improve adherence by offering realistic practice opportunities and feedback. We developed and evaluated a VR-based training program that uses the World Health Organization's (WHO) "My Five Moments for Hand Hygiene" framework to provide feedback about pathogen transmission and hand hygiene adherence in 4 clinical scenarios. Sixty-eight registered nurses from 4 hospitals in the United States completed the VR training program. Using the Theory of Planned Behavior, we assessed behavioral determinants (intention, attitudes, subjective norms, and perceived behavioral control [self-efficacy]) of hand hygiene adherence pre-, midway, and post training. We also measured overall adherence to the Five Moments in each scenario. From the beginning to the end of the training program, self-efficacy scores and overall hand hygiene adherence in VR increased linearly by 11% (P=.02) and 68% (P<.001), respectively. Our findings support VR as an educational tool for enhancing hand hygiene practices of health care workers. Future research should assess the transfer of training to clinical settings and its impact on real-world adherence and HAIs.