Clostridium difficile is an important cause of gastrointestinal infections associated with a wide range of diseases from asymptomatic carriage to antibiotic-associated diarrhea, colitis and potentially fatal pseudomembranous colitis. Antimicrobial therapy, increased age and severity of underlying illness are associated with increased risk of C. difficile acquisition. Patients who develop C. difficile-associated diarrhea are more likely to have been exposed to additional factors that altered the normal intestinal flora with the use of antibiotics, enemas and intestinal stimulants. There is good evidence that C. difficile is acquired nosocomially.
Mode of Transmission
C. difficile is transmitted directly from patient to patient via the hands of hospital personnel or indirectly through contaminated equipment such as bedpans, urinals, call bells and contaminated environmental surfaces i.e., bed rails, floors, and toilet seats. Contaminated hands are by far the most important means of transmission. Environmental contamination can result in a reservoir of C. difficile spores and serve as a source of organism that can spread to other patients. In addition, the spores are relatively resistant to most commonly used hospital disinfectants.
Policy
Patients with known or suspect C. difficile diarrhea, fecal incontinence or who are unable to practice good hygiene should be placed in a single room or alternately cohorted into a multiple bed room with other patients with similar status.
In addition to standard body substance precautions (i.e. protective barriers for contact with blood and body fluids) gloves and gowns must be worn for all direct patient contact and contact with the immediate environment of the patient.
Good hand washing with an antiseptic soap by all staff after direct contact with the patient or the immediate environment is necessary. The immediate environment must also be thoroughly cleaned and disinfected with 0.5% sodium hypochlorite. Phenolics and quaternary ammonium chlorides do not eliminate spores from environmental surfaces. Patients who remain asymptomatic without diarrhea or fecal incontinence for 72 hours and who are able to practice good hygiene may be transferred out of a single room.
Reusable equipment such as bedpans, bath basins, stethoscopes, etc. must be disinfected before use on another patient.
References
1) Johnson S, Gerding DN, Olson MM, Weiler MD, Hughes RA, Clabots CR, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridiumdifficile nosocomial transmission. Am J Med 1990;88:137-40.
2) Olson MM, Shanholtzer CJ, Lee JT, Gerding DN. Ten years of prospective Clostridium difficile-associated disease surveillance and treatment at the Minneapolis VA Medical Center, 1982-1991. Infect Control Hosp Epidemiol 1994;15(6):371-81.
3) Rao GG. Control of outbreaks of viral diarrhea in hospitals - a practical approach. J Hosp Infect 1995;30:1-6.
4) Silva J Jr, Iezzi C. Clostridium difficile as a nosocomial pathogen. J Hosp Infect 1988;11(Suppl A):378-85.
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