Clostridium-difficile - One Tough Bug
Many have recently
read in the press of outbreaks in hospitals of Clostridium difficile,
more commonly-known as C-difficile. It has become a major challenge for
Environmental Services Professionals trying to control the spread of this
pathogen in hospital settings.
In order to
control the spread we must first understand how this pathogen is transmitted
and then how to remove it from the environment. Clostridium difficile is spread
via the faecal oral route. The organism is ingested as the vegetative form or
as hardy spores, which can survive for long periods in the environments and can
traverse the acid of the stomach.
For C-difficile to
establish itself and proliferate in the colonic mucosa, the normal flora of the
colon must be disrupted and C-difficile must be ingested. Although these events
need not necessarily occur in that order.
Recent studies
state that more than 90 per cent of health care c-difficile infections occur
after or during anti-microbial therapy. As many patients in a hospital are
prescribed antibiotics, this leaves the patient population at risk. C-difficile
spread in hospitals has been well-documented, occurring primarily from
person-to-person and via contamination of the patient care environment.
Placing these
patients on contact precautions with a combination of vigilant hand hygiene is
an effective means of decreasing horizontal spread. Alcohol is not an effective
means of killing C-difficile spores. Hand washing should be done exclusively
using soap and water as per your organization’s hand washing policy and
procedure.
Environmental
contamination of C-difficile is due to the persistence of spores that can be
highly-resistant to routine disinfectants and can survive on dry surfaces for
many weeks and months. No disinfectants are registered with the U.S.
Environmental Protection Agency with a claim for C-difficile spore
inactivation.
The use of
hypochlorite solutions (bleach) has been recommended by infection control
agencies both in Canada and U.S. However, these solutions create strong odors
and can be very corrosive to environmental surfaces.
One approach that
is gaining prominence with housekeeping professionals is the use of microfibre
cloths.
Microfibre cloths
are densely constructed polyester and nylon fibres that are approximately 1/16
the thickness of a human hair. The fibres are split in such a way that it
creates hooks which scrape up dirt from the surface. The fibres also have a
positive charge which attracts negatively-charged dust.
Testing using
environmental cultures has shown microfibre cloths remove up to 99 per cent
more contaminants from surfaces. Instead of trying to kill the C-difficile
spores with disinfectants, the microfibre cloths trap and remove the spores
from the environment.
Touch surfaces
need to be targeted for enhanced environmental cleaning. Many organizations
have implemented housekeeping procedures, in which all rooms contaminated with
C-difficile are double cleaned on patient discharge. This is done to enhance
surface coverage by re-cleaning surfaces that may have been missed the first
time and to remove more contaminants from the environment. The double cleaning
procedure is labour intensive however, studies have estimated that C-difficile
associated disease costs an additional $3,669 to $7,234 per patient
hospitalization. This makes the business case clear for the double cleaning
procedure.
The housekeeping
professional is only one of the many health care professionals that must work
together in order to control the spread or outbreak of C-difficile in the
health care environment. Different strains of C-difficile are starting to
appear in North America and Europe that are more resistant and even more
deadly. This is one tough bug that will continue to be a challenge for some
time to come.
