Primary care clinics can be a source of exposure to virulent Clostridium (now Clostridioides) difficile: An environmental screening study of hospitals and clinics in Dallas-Fort Worth region

Abstract

C . difficile is an endospore-forming pathogen, which is becoming a common cause of microbial health-care associated gastrointestinal disease in the United States. Both healthy and symptomatic patients can shed C . difficile spores into the environment, which can survive for long periods, being resistant to desiccation, heat, and disinfectants. In healthcare facilities, environmental contamination with C . difficile is a major concern as a potential source of exposure to this pathogen and risk of disease in susceptible patients. Although hospital-acquired infection is recognized, community-acquired infection is an increasingly recognized health problem. Primary care clinics may be a significant source of exposure to this pathogen; however, there are limited data about presence of environmental C . difficile within clinics. To address the potential for primary care clinics as a source of environmental exposure to virulent C . difficile , we measured the frequency of environmental contamination with spores in clinic examination rooms and hospital rooms in Dallas-Fort Worth (DFW) area of Texas. The ribotypes and presence of toxin genes from some environmental isolates were compared. Our results indicate primary care clinics have higher frequencies of contamination than hospitals. After notification of the presence of C . difficile spores in the clinics and an educational discussion to emphasize the importance of this infection and methods of infection prevention, environmental contamination in clinics was reduced on subsequent sampling to that found in hospitals. Thus, primary care clinics can be a source of exposure to virulent C . difficile , and recognition of this possibility can result in improved infection prevention, potentially reducing community-acquired C . difficile infections and subsequent disease.

Risk for Asymptomatic Household Transmission of Clostridioides difficile Infection Associated with Recently Hospitalized Family Members

“…Despite the increase in community-acquired CDI, relatively little research has focused on the household setting. Instead, most efforts to find the exposure sources for community-associated CDI have focused on healthcare settings outside hospitals, such as outpatient clinics and emergency departments (6,7), and nonhealthcare sources such as food (8), household pets (10), and even exposure to the agricultural industry (24). A few relatively small studies (10,25) and 1 large study (11) did identify potential secondary C. difficile transmission from symptomatic cases among household members.…”

“…For example, antimicrobial drug and proton-pump inhibitor (PPI) use increase the risk for communityassociated CDI (4,5). For some community-associated CDI cases, exposure to healthcare settings beyond hospitalization, including clinics and emergency departments (6,7), are associated with an increased risk for CDI. However, for some CDI cases, no clear exposure to healthcare facilities can be identified.…”

Clustering Disease of Clostridioides Difficile Infection: Implication for the Management in Internal Medicine

“…Environmental sanitation is important to limit the spread of CD spores, considering the latter can persist for long periods on all surfaces due to their intrinsic resistance to heat and disinfectants except hypochlorite-based products or hydrogen peroxide [94][95][96][97].…”