UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.e.
BACKGROUND
An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.


METHODS
The UVM was applied to the toilets of patients who were on isolation precautions due to Clostridium difficile-associated diarrhea (CDAD) as well as for patients who were not on isolation precautions. Cleaning was visually scored using a numeric system where 0, 1, 2, and 3 represented; no, light, moderate or heavy residual UVM. Rodac plates containing CDMN selective agar were used to test for the presence of C. difficile on the surfaces of patient's toilets.


RESULTS
Despite twice daily cleaning for the toilets of patients who were on CDAD isolation precautions, the average cleaning score was 1.23 whereas the average cleaning score for toilets of patients not on isolation precautions was 0.9. Even with optimal cleaning (UVM score of 0) C. difficile was detected from 33% of the samples taken from toilets of patients with CDAD (4% detection in toilet samples from patients who had diarrhea not due to CDAD).


CONCLUSIONS
Our data demonstrated the value of UVM for monitoring the compliance of housekeeping staff with the facility's toilet cleaning protocol. In addition to providing good physical cleaning action, agents with some sporicidal activity against C. difficile may be needed to effectively reduce the environmental reservoir.
Alfa
Michelle J
MJ
Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada. malfa@sbgh.mb.ca
Dueck
Christine
C
Olson
Nancy
N
Degagne
Pat
P
Papetti
Selena
S
Wald
Alana
A
Lo
Evelyn
E
Harding
Godfrey
G
D000891:Anti-Infective Agents, Local / Q000494:pharmacology; D016360:Clostridioides difficile / Q000302:isolation & purification* / Q000502:physiology; D003428:Cross Infection / Q000517:prevention & control; D003470:Culture Media; D003967:Diarrhea / Q000382:microbiology*; D004203:Disinfection / Q000379:methods; D006797:Housekeeping, Hospital / Q000592:standards*; D006801:Humans; D006861:Hydrogen Peroxide / Q000494:pharmacology; D017053:Infection Control; D010356:Patient Isolation; D013171:Spores, Bacterial / Q000302:isolation & purification* / Q000502:physiology; D014038:Toilet Facilities / Q000592:standards*; D014466:Ultraviolet Rays
D000891:Anti-Infective Agents, Local; D003470:Culture Media; D006861:Hydrogen Peroxide