title: Infection control measures to limit the spread of Clostridium difficile.
abstract: Clostridium difficile-associated diarrhoea (CDAD) presents mainly as a nosocomial infection, usually after antimicrobial therapy. Many outbreaks have been attributed to C. difficile, some due to a new hyper-virulent strain that may cause more severe disease and a worse patient outcome. As a result of CDAD, large numbers of C. difficile spores may be excreted by affected patients. Spores then survive for months in the environment; they cannot be destroyed by standard alcohol-based hand disinfection, and persist despite usual environmental cleaning agents. All these factors increase the risk of C. difficile transmission. Once CDAD is diagnosed in a patient, immediate implementation of appropriate infection control measures is mandatory in order to prevent further spread within the hospital. The quality and quantity of antibiotic prescribing should be reviewed to minimise the selective pressure for CDAD. This article provides a review of the literature that can be used for evidence-based guidelines to limit the spread of C. difficile. These include early diagnosis of CDAD, surveillance of CDAD cases, education of staff, appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks. Existing local protocols and practices for the control of C. difficile should be carefully reviewed and modified if necessary.
authors.affiliation: Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany. Vonberg.Ralf@MH-Hannover.DE
authors.forename: R-P
authors.initials: RP
authors.lastname: Vonberg
authors.forename: E J
authors.initials: EJ
authors.lastname: Kuijper
authors.forename: M H
authors.initials: MH
authors.lastname: Wilcox
authors.forename: F
authors.initials: F
authors.lastname: Barbut
authors.forename: P
authors.initials: P
authors.lastname: Tüll
authors.forename: P
authors.initials: P
authors.lastname: Gastmeier
authors.forename: P J
authors.initials: PJ
authors.lastname: van den Broek
authors.forename: A
authors.initials: A
authors.lastname: Colville
authors.forename: B
authors.initials: B
authors.lastname: Coignard
authors.forename: T
authors.initials: T
authors.lastname: Daha
authors.forename: S
authors.initials: S
authors.lastname: Debast
authors.forename: B I
authors.initials: BI
authors.lastname: Duerden
authors.forename: S
authors.initials: S
authors.lastname: van den Hof
authors.forename: T
authors.initials: T
authors.lastname: van der Kooi
authors.forename: H J H
authors.initials: HJ
authors.lastname: Maarleveld
authors.forename: E
authors.initials: E
authors.lastname: Nagy
authors.forename: D W
authors.initials: DW
authors.lastname: Notermans
authors.forename: J
authors.initials: J
authors.lastname: O'Driscoll
authors.forename: B
authors.initials: B
authors.lastname: Patel
authors.forename: S
authors.initials: S
authors.lastname: Stone
authors.forename: C
authors.initials: C
authors.lastname: Wiuff
mesh_terms: D016360:Clostridioides difficile / Q000254:growth & development*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D003967:Diarrhea / Q000382:microbiology / Q000517:prevention & control; D004761:Enterocolitis, Pseudomembranous / Q000382:microbiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D017408:Guidelines as Topic; D006801:Humans; D017053:Infection Control / Q000379:methods*