Environmental approaches to controlling Clostridioides difficile infection in healthcare settings

Abstract

As today’s most prevalent and costly healthcare-associated infection, hospital-onset Clostridioides difficile infection (HO-CDI) represents a major threat to patient safety world-wide. This review will discuss how new insights into the epidemiology of CDI have quantified the prevalence of C. difficile (CD) spore contamination of the patient-zone as well as the role of asymptomatically colonized patients who unavoidable contaminate their near and distant environments with resilient spores. Clarification of the epidemiology of CD in parallel with the development of a new generation of sporicidal agents which can be used on a daily basis without damaging surfaces, equipment, or the environment, led to the research discussed in this review. These advances underscore the potential for significantly mitigating HO-CDI when combined with ongoing programs for optimizing the thoroughness of cleaning as well as disinfection. The consequence of this paradigm-shift in environmental hygiene practice, particularly when combined with advances in hand hygiene practice, has the potential for significantly improving patient safety in hospitals globally by mitigating the acquisition of CD spores and, quite plausibly, other environmentally transmitted healthcare-associated pathogens.

Early identification of a ward-based outbreak of Clostridioides difficile using prospective multilocus sequence type-based Oxford Nanopore genomic surveillance

“…Chemical disinfection with sporicidal agents is effective in controlling CDI in endemic and outbreak settings. 1 In an evaluation of four products, in both wipe and spray format, aHP showed the greatest reduction in viable spores and cleaning efficiency on surfaces for endemic and hypervirulent C. difficile strains. 40 Implementation of aHP wipes for routine and equipment cleaning in addition to preexisting hypochlorite-based terminal cleaning was likely an important intervention in our setting.…”

“…Clostridioides difficile infection (CDI) represents a significant threat to the safe delivery of modern healthcare. 1,2 Most CDI is genomically diverse; 3 however, a significant minority is associated with inpatient transmission events, and hospital outbreaks are well-described. 4,5 C. difficile is difficult to eradicate from the environment and healthcare workers' hands due to its propensity to form spores.…”

“…4,5 C. difficile is difficult to eradicate from the environment and healthcare workers' hands due to its propensity to form spores. 1,6,7 Residence in a room following a patient with CDI is a risk factor for acquiring the infection, [8][9][10] supporting the importance of inpatient transmission of C. difficile. Detecting outbreaks at an early stage based on incidence alone has performed poorly.…”