Environmental Control to Reduce Transmission ofClostridium difficile

Abstract

Restrictive antibiotic policies and infection control measures have been shown to reduce the incidence of Clostridium difficile-associated diarrhea (CDAD) among hospitalized patients. To date, the role of environmental disinfectants in reducing nosocomial CDAD rates has not been well studied. In a before-and-after intervention study, patients in 3 units were evaluated to determine if unbuffered 1:10 hypochlorite solution is effective as an environmental disinfectant in reducing the incidence of CDAD. Among 4252 patients, the incidence rate of CDAD for bone marrow transplant patients decreased significantly, from 8.6 to 3.3 cases per 1000 patient-days (hazard ratio, 0.37; 95% confidence interval, 0.19-0.74), after the environmental disinfectant was switched from quaternary ammonium to 1:10 hypochlorite solution in the rooms of patients with CDAD. Reverting later to quaternary ammonium solution increased the CDAD rate to 8.1 cases per 1000 patient-days. No reduction in CDAD rates was seen among neurosurgical intensive care unit and general medicine patients, for whom baseline rates were 3.0 and 1.3 cases per 1000 patient-days, respectively. Unbuffered 1:10 hypochlorite solution is effective in decreasing patients' risk of developing CDAD in areas where CDAD is highly endemic. Presumed mechanisms include reducing the environmental burden and the potential for C. difficile transmission among susceptible patients.

Strategies to Prevent Clostridium difficile Infections in Acute Care Hospitals

“…However, a beneficial effect has been reported when bleach has been used in outbreak settings or settings of hyperendemicity, typically in conjunction with other enhanced CDI control measures. 40,[50][51][52][53] b. When diluted sodium hypochlorite is instituted for environmental decontamination, it is necessary to coordinate activities with housekeeping staff.…”

Alternative treatments for Clostridium difficile disease: what really works?

“…A more effective strategy than treating asymptomatic carriers for the control of CDAD outbreaks involves strict infectioncontrol practices, especially handwashing, use of gloves and environmental decontamination (Gerding et al, 1995;Mayfield et al, 2000;Thomas et al, 2002). Surveillance for new cases of CDAD and prompt treatment to limit nosocomial spread is also important.…”

Improved control of nosocomial C. difficile transmission by daily use of an oxygen-releasing sporicidal disinfectant

“…17 to prevent environmental surface-mediated transmission, professional societies recommend daily disinfection of patients' adjacent surfaces and frequently touched objects in CDI patient rooms using sporicidal agents. 9,18,19 In contrast to oxygenreleasing based sporicidal wipe disinfectants, the effectiveness of chlorine-based agents for sporicidal disinfection in medical environments has been established in several studies. [19][20][21] However, the use of chlorine-based disinfectants is associated with health and safety concerns and material compatibility.…”