The Hospital Environment as a Potential Source for Clostridioides difficile Transmission Based on Spore Detection Surveys Conducted at Paediatric Oncology and Gastroenterology Units

Abstract

Clostridioides difficile is an anaerobic, Gram-positive bacterium widely present in the hospital environment due to its ability to generate spores. The transfer of spores to patients through the hands of medical personnel is one of the most frequent paths of C. difficile transmission. In paediatric patients burdened with a serious primary illness requiring long-term hospitalisation and antibiotic therapy, C. difficile may be a significant risk factor for antibiotic-associated diarrhoea. The goal of the study was to assess the state of hospital environments as a potential source of C. difficile spores and to establish the share of hyperepidemic strains at the two paediatric units. The survey for C. difficile was conducted with a C. diff Banana BrothTM medium, used to detect spores and to recover vegetative forms of the bacteria. Environmental samples (n = 86) and swabs from the clothing of medical personnel (n = 14) were collected at two units of a paediatric hospital, where the cases of antibiotic-associated diarrhoea with a C. difficile aetiology constitute a significant clinical problem. In 17 samples, a change in the broth’s colour was observed, indicating the presence of spores. Out of seven samples, C. difficile strains were cultured. The pathogenic isolates of C. difficile were obtained from swabs collected from elements of beds, a toilet, a door handle and a doctor’s uniform. In our study, we indicated points of increased risk of pathogen transmission, which could constitute a source of infection. The clothing of medical personnel may be a dangerous carrier of pathogenic spores. Periodical surveys of hospital environments with the use of specialist microbiological mediums successfully indicate the direction of corrective actions to be undertaken by the medical facility in order to increase patient safety.

Microbiome-Related and Infection Control Approaches to Primary and Secondary Prevention of Clostridioides difficile Infections

“…Developing strategies to prevent CDI requires an understanding of how C. difficile is transmitted and which factors may increase the risk of a person developing an initial episode of CDI or recurrent episodes. The transmission of C. difficile has been well documented by many studies in healthcare settings since 1989 and show C. difficile spores are shed by CDI patients to environmental surfaces, may be carried on hands and clothing of hospital staff and visitors, and may infect roommates and hospital personnel [ 23 , 24 ]. The source of community-acquired cases of CDI may be spores from soil, animals, or asymptomatic carriers recently discharged from healthcare facilities [ 25 , 26 ].…”

“…Our review updated the existing knowledge on these various avenues and we described the progress made in the past five years (2018)(2019)(2020)(2021)(2022)(2023). Previous studies documented the effectiveness of using infection control bundles consisting of surveillance for CDI cases, enhanced hand washing and use of personal protective equipment, cohorting CDI cases, and sporicidal disinfection of environmental surfaces [23,25]. As the use of antibiotics is the most common cause of microbiome disruption, antibiotic stewardship programs (ASPs) that evaluate rational uses of antibiotics and reduce the inappropriate use of antibiotics have dramatically reduced incident CDI cases.…”

Clostridioides difficile Infections among Pediatric Patients Hospitalized at an Oncology Department of a Tertiary Hospital in Poland

“…The study was performed using C. diff Banana Broth™ medium (Hardy Diagnostics, Santa Maria, USA), which is used for culturing and recovering CD spores and vegetative cells from environmental samples. The obtained results indicate the main sources of spore transmission and the need for continuous monitoring of the situation of high-risk patients, in whom long-term contact with the hospital environment is a very significant prognostic factor for the occurrence of a CDI [ 33 ]. In this perspective, nutrition disorders and the use of assisted feeding may open the gates for the colonization of the gastrointestinal tract due to the difficulties of maintaining strict aseptic conditions.…”

Clostridioides difficile detection and infection in children: are they just small adults?

“…One investigation recovered C. difficile from 7/100 samples from the ward environments and staff clothing on a gastroenterology and an oncology unit. Five of the seven isolates here were determined to be toxigenic, with one environmental isolate being ribotype 027 [79]. Further research identified high rates of asymptomatic carriage of C. difficile in a neonatal intensive care unit (NICU) (25.7%), with 2 out of 29 associated environmental sites detected positive for C. difficile .…”