Efficacy of Sodium Hypochlorite-Based Disinfectants Against Clostridium difficile Spores

Abstract

0 8 , VOL. 2 9 , NO. 2 to these symptoms and those listed in the CTCAE for diarrhea, we added hypothermia.The nature of our study population (ie, allogeneic hematopoietic stem cell transplant recipients) precludes the use of several of the other severity criteria mentioned by Jaber et al. 1 Many of the patients were neutropenic, making white blood cell counts frequently inapplicable. All of the subjects were immunosuppressed, and therefore immunosuppression is not a useful criterion for assessing the risk of poor outcomes due to CD AD in this patient population. Measurement of the lactate level is not routinely done, and it is unlikely that many of our patients would have had a sample for lactate measurement obtained within 48 hours of CD AD diagnosis. Patients with a significant increase in lactate level would likely be hypotensive as well, and hypotension is captured under the criteria for diarrhea, grades 2-4.Our primary goal in creating a CDAD severity grading system was to develop a scale that could identify patients who are at high risk for poor outcomes, early in their clinical course. Previous CDAD severity grading systems, including those mentioned by Jaber et al., 1 were not limited to symptoms present early in a patient's clinical course. Pepin et al. 4 included death within 30 days of diagnosis in their definition of a complicated CDAD case. Dallal et al. 5 developed their CDAD severity system based on outcomes, not presenting symptoms; the defining criteria for fulminant colitis were death or the requirement for emergency colectomy. Although the grading systems developed by Pepin et al. 4 and Dallal et al. 5 undeniably identify cases of severe CDAD, their ability to classify CDAD severity at the time of diagnosis has not been validated. The studies of Pepin et al. 4 and Dallal at al., 5 as well as our own, were also limited by being retrospective. To the best of our knowledge, no studies exist that prospectively validate any CDAD severity grading system. We are currently conducting a prospective study of CDAD in allogeneic hematopoietic stem cell transplant recipients, and this study should provide additional data on the usefulness of our CDAD severity grading system in that patient population. Fawley et al. 1 presented data that indicated certain chlorine-based germicides were able to inactivate C. difficile spores, when used at recommended working concentrations. These results coincide with those of other studies on C. difficile spores that have been conducted using chlorine-based germicides at the recommended working strength and with recommendations by the Centers for Disease Control and Prevention. 2 " 6 Studies such as these provide valuable information for infection control professionals in healthcare facilities, especially since the US Enivornmental Protection Agency does not currently recognize a test method for inactivation of C. difficile spores. As valuable as the reported efficacy information is, however, the rest of the article by Fawley et al' quickly loses relevance. The m...