Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance.
The recognition of a cluster of antibiotic-associated nosocomial Clostridium difficile disease (NCDD) caused by serotype C in a surgical ward led to a hospital-wide NCDD surveillance and control program. The initial step included: (a) gas-liquid chromatography screening of inpatients' diarrheal stools; (b) enteric isolation precautions, cohorting and terminal room disinfection in wards with a cluster of two or more NCDD cases per month. During a 12-month period, the quarterly incidence of NCDD remained unchanged and six new clusters of serotype C, K, and H infections occurred, giving a global incidence of 1.5/1,000 admissions. C. difficile spores were recovered from 36.7% surfaces of case patient rooms versus 6.7% in control rooms. More intensive control measures were evaluated: (a) culture screening of inpatients' diarrheal stools; (b) early therapy, enteric isolation precautions, and daily meticulous room disinfection for each sporadic NCDD case. Surface disinfection reduced the contamination level four-fold (p = 0.04). In the following 12 months, no cluster occurred and the incidence of NCDD fell to 0.3/1,000 admission (protective efficacy 73%, 95% confidence interval: 46-87%). These observations suggest that early therapy, isolation precautions, and surface disinfection, focused on patients with sporadic NCDD detected by active surveillance, can prevent nosocomial transmission of C. difficile.
Hospital Epidemiology and Infection Control Unit, Hôpital Erasme, Bruxelles, Belgium.
M J
MJ
Struelens
A
A
Maas
C
C
Nonhoff
A
A
Deplano
F
F
Rost
E
E
Serruys
M
M
Delmee
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D002648:Child; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000517:prevention & control*; D004196:Disease Outbreaks; D004761:Enterocolitis, Pseudomembranous / Q000453:epidemiology / Q000517:prevention & control / Q000635:transmission; D005260:Female; D006801:Humans; D017053:Infection Control; D008297:Male; D008875:Middle Aged