Acquisition of Clostridium Difficile From the Hospital Environment1

Kaatz, Glenn W.; Gitlin, Scott D.; Schaberg, Dennis R.; Wilson, Kenneth H.; Kauffman, Carol A.; Seo, Susan M.; Fekety, Robert

doi:10.1093/oxfordjournals.aje.a114921

Cited by 216 publications

(111 citation statements)

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“…However, the difference in prevalence among studies may be due to the sampling and culture methods used [70] and in the cleaning programmes used to control the spread of C. difficile. In this context, a previous study reported that unbuffered hypochlorite (500 ppm) was less effective than phosphate buffered hypochlorite (1600 ppm) for surface decontamination [72]. In addition to the patient room environment, the bacterium was isolated from the hands and stools of asymptomatic hospital staff and from the home of a patient suffering CDI.…”

Section: Difficile Is Found Everywherementioning

confidence: 98%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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a b s t r a c tRecognised as the leading cause of nosocomial antibiotic-associated diarrhoea, the incidence of Clostridium difficile infection (CDI) remains high despite efforts to improve prevention and reduce the spread of the bacterium in healthcare settings. In the last decade, many studies have focused on the epidemiology and rapid diagnosis of CDI. In addition, different typing methods have been developed for epidemiological studies. This review explores the history of C. difficile and the current scope of the infection. The variety of available laboratory tests for CDI diagnosis and strain typing methods are also examined.

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Section: Difficile Is Found Everywherementioning

confidence: 98%

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Rodríguez

Broeck

Taminiau

et al. 2016

Microbial Pathogenesis

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“…However, a beneficial effect has been reported when bleach has been used in outbreak settings or settings of hyperendemicity, typically in conjunction with other enhanced CDI control measures. 40,[50][51][52][53] b. When diluted sodium hypochlorite is instituted for environmental decontamination, it is necessary to coordinate activities with housekeeping staff.…”

Section: Place Patients With Diarrhea Under Contact Precautions Whilementioning

confidence: 99%

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Dubberke

Gerding

Classen

et al. 2008

Infect. Control Hosp. Epidemiol.

189

194

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Previously published guidelines are available that provide comprehensive recommendations for detecting and preventing healthcare-associated infections. The intent of this document is to highlight practical recommendations in a concise format designed to assist acute care hospitals in implementing and prioritizing their Clostridium difficile infection (CDI) prevention efforts. Refer to the Society for Healthcare Epidemiology of America/Infectious Diseases Society of America “Compendium of Strategies to Prevent Healthcare-Associated Infections” Executive Summary and Introduction and accompanying editorial for additional discussion.1. Increasing rates of CDIC. difficile now rivals methicillin-resistant Staphylococcus aureus (MRSA) as the most common organism to cause healthcare-associated infections in the United States.a. In the United States, the proportion of hospital discharges in which the patient received the International Classification of Diseases, Ninth Revision discharge diagnosis code for CDI more than doubled between 2000 and 2003, and CDI rates continued to increase in 2004 and 2005 (L. C. McDonald, MD, personal communication, July 2007). These increases have been seen in pediatric and adult populations, but elderly individuals have been disproportionately affected. CDI incidence has also increased in Canada and Europe.b. There have been numerous reports of an increase in CDI severity.c. Most reports of increases in the incidence and severity of CDI have been associated with the BI/NAP1/027 strain of C. difficile. This strain produces more toxins A and B in vitro than do many other strains of C. difficile, produces a third toxin (binary toxin), and is highly resistant to fluoroquinolones.

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“…Bacterial spores have been found in far greater quantities in the environment around indi-viduals with CDI in comparison with asymptomatically colonized patients, presumably secondary to diarrhoea, which can often be unexpected and explosive, so increasing shedding of C. difficile [7]. C. difficile spores are highly resistant to many commonly used disinfectants and may persist for many months in hospital ward environments [8].…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology of endemic Clostridium difficile infection

Fawley

Wilcox

2001

Epidemiol. Infect.

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SUMMARYThis is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1-3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r l 0n76, P 0n05) but not on ward A (r l 0n26, P 0n05). We found that RAPD and RS-PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90 % of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and\or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled.

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Acquisition of Clostridium Difficile From the Hospital Environment1

Cited by 216 publications

References 0 publications

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Clostridium difficile infection: Early history, diagnosis and molecular strain typing methods

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

Molecular epidemiology of endemic Clostridium difficile infection

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