How to Prevent C difficile Infection: A New Guide

Laura A. Stokowski, RN, MS

Disclosures

May 24, 2013

In This Article

Transmission of C difficile

Acquisition of CDI is usually by ingesting spores found in the environment that were shed by another patient. C difficile spores are not destroyed by gastric acidity; they are able to bypass the stomach to reach the small intestine, where they germinate into vegetative bacteria.[2]

The role of the environment in CDI first became clear in experiments with hamsters. When culture-negative hamsters were given antibiotics and placed in cages that previously held infected animals, the hamsters developed CDI with the same bacteriocin type of toxigenic C difficile as the former occupants.[8] These experiments suggested that cross-infection with C difficile was important in the pathogenesis of antibiotic-associated colitis, supporting recommendations to use contact precautions when caring for patients with CDI in the hospital environment.

In a healthcare setting, the beds in which patients rest, the toilets they use, the everyday items that they handle can become contaminated with C difficile spores. These spores are hardy. They don't die in a few hours of exposure to air, like vegetative C difficile bacteria. Spores persist for many months and are not eradicated with routine cleaning and disinfection methods.

To make matters worse, it takes only a few spores to infect another person. If another patient happens to share the same bathroom, these spores might easily be found on the flush mechanism, the sink faucet, or the door handle. Before the infected patient is identified and placed in isolation, countless opportunities exist for transmitting the infection to another patient. After the isolated patient is discharged, it is alarmingly simple to miss a few areas when terminally cleaning the room and its contents before the next patient arrives.

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