Isolation of Clostridium difficile from patients and the environment of hospital wards.

Abstract

SUMMARY Rectal swabs from 122 patients and 497 environmental swabs from several wards were examined for the presence of Clostridium difficile in order to assess the role of the environment in the spread of this organism. Clostridium difficile was isolated from 6/27 (22-2%) oncology patients and from 8/163 (4 9%) environmental specimens obtained from the oncology unit. Items found positive for C difficile were those subjected to faecal contamination such as commode chairs, bed pans, dust pans, discard bins, the sluice and a disposable bed pan machine.Fourteen of 51 (27-4%) asymptomatic neonates yielded mostly toxigenic C difficile in their stools during their first week of life. Five of 156 (3-2%) specimens taken from inanimate objects in the environment of the neonatal units were positive for C difficile. The organism was also isolated from the hands of a nurse.Similar antibiogram patterns were demonstrated in the strains obtained from the patients and their environment indicating the possible occurrence of cross infection.These results indicate that environmental contamination is important in the spread of C difficile in hospitalised patients and the implementation of isolation procedures may limit that spread.

Vaginal carriage and neonatal acquisition of Clostridium difficile

“…The overall isolation rate of 62% found in the neonates is similar to previous reports (Hall and O'Toole, 1935;Viscidi, Willey and Bartlett, 198 1;Larson et al, 1982;Malamou-Ladas et al, 1983). Yet there was a variation in the frequency of C. dzficile isolation during the 5-month study period, in the neonates and in the mothers, suggestive of clustering of cases with possible cross-contamination ( figure).…”

“…There was still a considerable number of babies (56%) who acquired the organism from other sources, such as the environment; this is particularly well demonstrated in four of the eight babies delivered by Caesarian section who became colonised. Environmental surveys in maternity units and neonatal wards have produced evidence for the widespread presence of C. dzficile on inanimate objects (Viscidi et al, 1981, Larson et al, 1982Malamou-Ladas et al, 1983), and also on nurses' fingers (Malamou-Ladas et al, 1983).…”

“…This bacterium, however, may also be isolated from the faeces of 2-60% of asymptomatic infants and neonates (Hall and O'Toole, 1935;Holst, Helin and Mardh, 1981;Larson et al, 1982;Nash et al, 1982;Malamou-Ladas et al, 1983). Neither the significance of this high isolation rate in neonates nor the source of the organism has yet been determined.…”

“…An explanation for the discrepancy between these results might be differences in the methods used by the investigators for transport and culture of the specimens. Alternatively, other sources of C. dzjicile, such as the environment, may determine neonatal colonisation (Larson et al, 1982;Malamou-Ladas et al, 1983).…”

Prospective study ofClostridium difficilecolonization and para-cresol detection in the stools of babies on a special care unit

“…This and other exogenous sources may be important in nosocomial transmission of Cl. difficile (Rogers et al 1981;Malamou-Ladas et al 1983). Once the infants had acquired Cl.…”