Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance

Struelens, Marc; Maas, Axel; Nonhoff, Claire; Deplano, Ariane; Rost, F.; Serruys, Elisabeth Schoutens; Delmée, Michel

doi:10.1016/0002-9343(91)90359-6

Cited by 63 publications

(46 citation statements)

References 28 publications

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“…1013 However, these data call into question whether sporicidal activity is required in a nonepidemic setting, 14 and further research would certainly be needed to explain these findings. 15 Enterococci were isolated from the environment even shortly after disinfection, as already observed by Weber and Rutala 16 and Anderson et al 17 for VRE. A stricter adherence to disinfection protocols was therefore recommended by Anderson et al 17 VRE are becoming more and more problematic in hospitals and cause epidemic outbreaks, even though not all VRE are associated with outbreaks.…”

Section: Discussionsupporting

confidence: 53%

Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

Meinke

Meyer

Frei

et al. 2012

Infect. Control Hosp. Epidemiol.

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Background.The inanimate hospital environment has emerged as an important reservoir of nosocomial pathogens. In particular, multidrug-resistant pathogens, such as methicillin-resistant Staphylococcus aureus, Acinetobacter species, and Clostridium difficile, play a major role in the transmission of hospital-acquired infections. In Europe, aldehydes, chlorine, and quaternary ammonium compounds have been commonly used for environmental disinfection. Glucoprotamin, a newer active compound for disinfectants, has been clinically tested for disinfection of instruments but not for environmental disinfection.Objective.This study evaluated the antimicrobial effectiveness of a glucoprotamin-containing product (Incidin) compared with that of an aldehyde-containing product (Deconex), the current standard at our institution.Methods.This prospective crossover study was conducted in our access-restricted hematologic transplant unit. A total of 3,086 samples from the environment were processed and examined for overall bacterial burden as well as selectively for S. aureus, C. difficile, and gram-negative bacteria.Results.There was no significant difference in residual bacteria after disinfection between the 2 products in terms of overall burden and selected pathogens. Enterococci were the predominant pathogens recovered from surfaces, but no vancomycin-resistant enterococci were recovered. Similarly, C. difficile could not be found in the patients' environment, even in rooms, despite the use of selective media.Conclusion.The aldehyde-containing product (Deconex) and the glucoprotamin-containing product (Incidin) demonstrated similar efficacy against environmental contamination in a hematologic transplant unit with the application of selective media for C. difficile, S. aureus, and gram-negative bacteria in addition to standard medium.

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Section: Discussionsupporting

confidence: 53%

Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

Meinke

Meyer

Frei

et al. 2012

Infect. Control Hosp. Epidemiol.

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“…96 The use of private rooms with implementation of enteric or contact precautions has been successful in limiting transmission of C. difficile in hospital and long-term care settings. [97][98][99][100][101] Because this measure has generally been introduced along with other infection control measures, it is not known how effective it would be if used alone.…”

Section: Preventive Measuresmentioning

confidence: 99%

Clostridium difficile-associated diarrhea in adults

Poutanen

Simor²

2004

Canadian Medical Association Journal

360

280

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CLOSTRIDIUM DIFFICILE is the most important cause of nosocomial diarrhea in adults. Illness may range from mild watery diarrhea to life-threatening colitis. An antecedent disruption of the normal colonic flora followed by exposure to a toxigenic strain of C. difficile are necessary first steps in the pathogenesis of disease. Diagnosis is based primarily on the detection of C. difficile toxin A or toxin B. First-line treatment is with oral metronidazole therapy. Treatment with oral vancomycin therapy should be reserved for patients who have contraindications or intolerance to metronidazole or who fail to respond to first-line therapy

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“…Bacterial spores have been found in far greater quantities in the environment around indi-viduals with CDI in comparison with asymptomatically colonized patients, presumably secondary to diarrhoea, which can often be unexpected and explosive, so increasing shedding of C. difficile [7]. C. difficile spores are highly resistant to many commonly used disinfectants and may persist for many months in hospital ward environments [8]. Additionally, it has been shown that the frequency of C. difficile positive healthcare personnel hand cultures was highly correlated with the intensity of environmental contamination [9].…”

Section: Introductionmentioning

confidence: 99%

Molecular epidemiology of endemic Clostridium difficile infection

Fawley

Wilcox

2001

Epidemiol. Infect.

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SUMMARYThis is the first study to provide a comprehensive insight into the molecular epidemiology of endemic Clostridium difficile and particularly that associated with a recently recognized epidemic strain. We DNA fingerprinted all C. difficile isolates from the stools of patients with symptomatic antibiotic-associated diarrhoea and from repeated samples of the inanimate ward environment on two elderly medicine hospital wards over a 22-month period. Notably, C. difficile was not recoverable from either ward immediately before opening, but was found on both wards within 1-3 weeks of opening, and the level of environmental contamination rose markedly during the first 6 months of the study period. C. difficile infection (CDI) incidence data correlated significantly with the prevalence of environmental C. difficile on ward B (r l 0n76, P 0n05) but not on ward A (r l 0n26, P 0n05). We found that RAPD and RS-PCR typing had similar discriminatory power, although, despite fingerprinting over 200 C. difficile isolates, we identified only six distinct types. Only two distinct C. difficile strains were identified as causing both patient infection and ward contamination. Attempts to determine whether infected patients or contaminated environments are the prime source for cross-infection by C. difficile had limited success, as over 90 % of C. difficile isolates were the UK epidemic clone. However, a non-epidemic strain caused a cluster of six cases of CDI, but was only isolated from the environment after the sixth patient became symptomatic. The initial absence of this strain from the environment implies patient-to-patient and\or staff-to-patient spread. In general, routine cleaning with detergent was unsuccessful at removing C. difficile from the environment. Understanding the epidemiology and virulence of prevalent strains is important if CDI is to be successfully controlled.

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Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance

Cited by 63 publications

References 28 publications

Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

Equal Efficacy of Glucoprotamin and an Aldehyde Product for Environmental Disinfection in a Hematologic Transplant Unit: A Prospective Crossover Trial

Clostridium difficile-associated diarrhea in adults

Molecular epidemiology of endemic Clostridium difficile infection

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