We assessed environmental contamination of inpatient rooms housing COVID-19 patients in a dedicated COVID-19 unit. Contamination with SARS-CoV-2 was found on 5.5% (19/347) of surfaces via RT-PCR and 0.3% (1/347) of surfaces via cell culture. Environmental contamination is uncommon in hospitals rooms; RNA presence is not a specific indicator of infectious virus.

Differences in neutrophil functional capacity represent a fixed phenotype and are defined by distinct neutrophil gene expression profiles.

Objectives Shedding of Clostridioides difficile spores from infected individuals contaminates the hospital environment and contributes to infection transmission. We assessed whether antibiotic selection impacts C. difficile shedding and contamination of the hospital environment. Methods In this prospective, unblinded, randomized controlled trial of hospitalized adults with C. difficile infection, subjects were randomized 1:1:1 to receive fidaxomicin, oral vancomycin, or metronidazole. The primary outcome was change in environmental contamination rate while on treatment. Secondary outcomes included stool shedding, total burden of contamination, and molecular relatedness of stool versus environmental C. difficile isolates. Results 33 patients were enrolled and 31 (94%) completed the study. Fidaxomicin (-0.36 log10 CFU/day, 95% CI -0.52 to -0.19, p<0.01) and vancomycin (-0.17 log10 CFU/day, 95% CI -0.34 to -0.01, p=0.05) were associated with more rapid decline in C. difficile shedding compared to metronidazole (-0.01 log10 CFU/day, 95% CI -0.10 to +0.08). Both vancomycin (6.3%, 95% CI 4.7-8.3%) and fidaxomicin (13.1%, 95% CI 10.7-15.9%) were associated with lower rates of environmental contamination than metronidazole (21.4%, 95% CI 18.0-25.2%). When specifically modeling within-subject change over time, fidaxomicin (aOR 0.83, 95% CI 0.70-0.99, p=0.04) was associated with more rapid decline in environmental contamination than vancomycin or metronidazole. Overall, 207 of 233 (88.8%) of environmental C. difficile isolates matched subject stool isolates by ribotyping, without significant difference by treatment. Conclusions Fidaxomicin, and to a lesser extent vancomycin, reduces C. difficile shedding and contamination of the hospital environment relative to metronidazole. Treatment choice may play a role in reducing healthcare-associated C. difficile transmission.

Introduction Patients with Clostridioides difficile infections (CDI) contaminate the healthcare environment; however, the relative contribution of contamination by colonized individuals is unknown. Current guidelines do not recommend the use of contact precautions for asymptomatic C. difficile carriers. We evaluated C. difficile environmental contamination in rooms housing adult inpatients with diarrhea based on C. difficile status. Methods We performed a prospective cohort study of inpatient adults with diarrhea who underwent testing for CDI via PCR and enzyme immunoassay. Patients were stratified into cohorts based on test result: infected (PCR +/EIA +), colonized (PCR +/EIA -) or negative/control (PCR -). Environmental microbiological samples were taken within 24 hours of C. difficile testing and again for two successive days. Samples were obtained from the patient, bathroom, and care areas. Results We enrolled 94 patients between November 2019 and June 2021. C. difficile was recovered in 93 (38%) patient rooms: 44 (62%) infected patient rooms, 35 (43%) colonized patient rooms (p=0.08 vs. infected 38 patient rooms), and 14 (15%) negative patient rooms (p<0.01 vs. infected; p<0.01 vs. colonized). C. difficile was recovered in 40 (56%), 6 (9%) and 20 (28%) of bathrooms, care areas and patient areas in 40 infected patient rooms; 34 (41%), 1 (1%), and 4 (5%) samples in colonized patient rooms; and 12 (13%), 41 1 (1%), and 3 (3%) of samples in negative patient rooms, respectively. Conclusion Patients colonized with C. difficile frequently contaminated the hospital environment. Our data support the use of contact precautions when entering rooms of patients colonized with C. difficile, especially when entering the bathroom.