Clostridium difficile Infection It's a Family Affair

Abstract

tipped swab (Fisher Scientific) premoistened in Dey-Engley neutralizer (Becton Dickinson). The swabs were vortexed for 45 seconds in 200 piL of Dey-Engley neutralizer, plated onto prereduced C. difficile Brucella agar (CDBA), and cultured as previously described. 7 For the fresh Clorox premoistened germicidal wipes only, an additional experiment was performed in which the inoculated site was wiped for 10 seconds and then sequentially imprinted onto 5 prereduced CDBA plates containing Dey-Engley neutralizer. All experiments were performed in triplicate. Figure 1 provides an illustration of the findings. Use of fresh Clorox premoistened germicidal wipes with 5 minutes of contact time consistently reduced C. difficile spores to undetectable levels at the inoculum site, with no transfer of spores to clean sites. In contrast, large numbers of spores were transferred to all four sequential clean sites by wipes moistened with the quaternary ammonium product or water (mean number of spores recovered from the fourth transfer site, 3 and 2.1 log 10 CFUs, respectively). The used Clorox wipes transferred spores to all 4 sequential sites but in much lower quantities (mean, 0.4 log 10 CFUs recovered from the fourth transfer site). Finally, fresh Clorox premoistened germicidal wipes transferred large quantities of spores (CFU too numerous to count) to 5 successive CDBA plates containing Dey-Engley neutralizer (i.e., minimal contact time with hypochlorite allowed because of rapid exposure to neutralizer).In summary, our results demonstrate efficient transfer of C. difficile spores from contaminated to clean surfaces by nonsporicidal wipes, as has previously been reported by Siani et al. 6 Moreover, our findings illustrate the potential for transfer of spores by hypochlorite wipes that are used inappropriately. In our facility, observations of housekeepers demonstrated that many workers changed hypochlorite wipes infrequently while others used paper towels to dry surfaces shortly after application of hypochlorite. As illustrated here, such practices can result in insufficient wet contact time for killing of spores. Our findings demonstrate the need to provide clear instructions to housekeepers on how wipes should be used and provide support for the recommendation that sporicidal disinfectants are preferred for surfaces in CDI rooms when feasible.3,4 For effective disinfection of C. difficile, a sporicidal product plus correct practices are essential.

Household Transmission ofClostridium difficileto Family Members and Domestic Pets

“…Transmission of CDI to household contacts has been described but was not supported by strain analysis 15 . Index cases who remain infected or colonized with C. difficile may be a reservoir for household members and pets, leading to CA-CDI.…”

“…Transmission of CDI to household contacts has been described but was not supported by strain analysis. 15 Index cases who remain infected or colonized with C. difficile may be a reservoir for household members and pets, leading to CA-CDI. The aim of this study was to document the risk of transmission of C. difficile from index cases to their household contacts, including pets, in a prospective systematic manner in conjunction with analysis of C. difficile isolates.…”