title: Comparison of the effect of detergent versus hypochlorite cleaning on environmental contamination and incidence of Clostridium difficile infection.
abstract: To determine how best to decontaminate the hospital environment of Clostridium difficile, we carried out a cross-over study on two elderly medicine wards to determine whether cleaning with a hypochlorite disinfectant was better than using neutral detergent in reducing the incidence of C. difficile infection (CDI). We examined 1128 environmental samples in two years, 35% of which grew C. difficile. There was a significant decrease of CDI incidence on ward X, from 8.9 to 5.3 cases per 100 admissions (P<0.05) using hypochlorite, but there was no significant effect on ward Y. On ward X the incidence of CDI was significantly associated with the proportion of culture-positive environmental sites (P<0.05). On ward Y the only significant correlation between CDI and C. difficile culture-positive environmental sites was in patient side-rooms (r=0.41, P<0.05). The total daily defined doses of cefotaxime, cephradine and aminopenicillins were similar throughout the trial. These results provide some evidence that use of hypochlorite for environmental cleaning may significantly reduce incidence of CDI, but emphasize the potential for confounding factors.
authors.affiliation: Department of Microbiology, General Infirmary at Leeds and University of Leeds, LS1 3EX, Leeds, UK. markwi@pathology.leeds.ac.uk
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
authors.forename: W N
authors.initials: WN
authors.lastname: Fawley
authors.forename: N
authors.initials: N
authors.lastname: Wigglesworth
authors.forename: P
authors.initials: P
authors.lastname: Parnell
authors.forename: P
authors.initials: P
authors.lastname: Verity
authors.forename: J
authors.initials: J
authors.lastname: Freeman
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects; D002353:Carrier State / Q000453:epidemiology / Q000517:prevention & control; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D015986:Confounding Factors, Epidemiologic; D003428:Cross Infection / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D018592:Cross-Over Studies; D003902:Detergents / Q000592:standards*; D003967:Diarrhea / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004202:Disinfectants / Q000592:standards*; D004363:Drug Utilization; D004783:Environmental Microbiology; D004866:Equipment Contamination / Q000517:prevention & control; D006225:Hand / Q000382:microbiology; D006797:Housekeeping, Hospital / Q000379:methods* / Q000592:standards; D006801:Humans; D006997:Hypochlorous Acid / Q000592:standards*; D015994:Incidence; D017053:Infection Control / Q000379:methods* / Q000592:standards; D012307:Risk Factors
chemical_list: D000900:Anti-Bacterial Agents; D003902:Detergents; D004202:Disinfectants; D006997:Hypochlorous Acid