Prevalence of Clostridium difficile environmental contamination and strain variability in multiple health care facilities.
BACKGROUND
Clostridium difficile spores can contaminate the hospital environment. Little is known about the prevalence and strain variability of C. difficile environmental contamination in health care facilities. The objective of this study was to assess C. difficile environmental contamination at various health care facilities in a metropolitan area and determine if the North American pulsed field gel electrophoresis type 1 (NAP1) strain was present.


METHODS
A cross-sectional pilot survey was conducted. Forty-eight environmental samples were collected from six health care facilities. Samples were cultured for the presence of C. difficile, and positive samples underwent pulsed field gel electrophoresis, toxinotyping, and detection of binary toxin and/or tcdC deletion.


RESULTS
C. difficile was cultured from 13 of 48 (27%) samples. Rooms housing a patient with C. difficile-associated disease (CDAD) were more likely to be culture positive than non-CDAD patient rooms (100% vs. 33%; P < 0.01); C. difficile was not isolated outside of patient rooms (0 of 12 samples). The NAP1 epidemic strain was found in 5 out of 6 facilities.


CONCLUSIONS
C. difficile spores frequently contaminated the hospital environment. Rooms with a CDAD patient were more likely to be contaminated than rooms without a CDAD patient. The NAP1 strain was prevalent throughout the metropolitan area.
Dubberke
Erik R
ER
Division of Infectious Diseases, Washington University School of Medicine, St. Louis, MO 63110, USA. edubberk@im.wustl.edu
Reske
Kimberly A
KA
Noble-Wang
Judith
J
Thompson
Angela
A
Killgore
George
G
Mayfield
Jennie
J
Camins
Bernard
B
Woeltje
Keith
K
McDonald
Jay R
JR
McDonald
L Clifford
LC
Fraser
Victoria J
VJ
D001427:Bacterial Toxins / Q000145:classification* / Q000302:isolation & purification; D016360:Clostridioides difficile / Q000145:classification* / Q000302:isolation & purification* / Q000472:pathogenicity; D003015:Clostridium Infections / Q000517:prevention & control; D003428:Cross Infection / Q000517:prevention & control; D003430:Cross-Sectional Studies; D004403:Dysentery / Q000517:prevention & control; D016521:Electrophoresis, Gel, Pulsed-Field; D004784:Environmental Monitoring; D062665:Epidemiological Monitoring; D004866:Equipment Contamination / Q000706:statistics & numerical data*; D006268:Health Facilities; D006801:Humans; D008923:Missouri / Q000453:epidemiology; D015995:Prevalence
D001427:Bacterial Toxins