title: 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.
abstract: 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.
authors.affiliation: Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada. malfa@sbgh.mb.ca
authors.forename: Michelle J
authors.initials: MJ
authors.lastname: Alfa
authors.forename: Christine
authors.initials: C
authors.lastname: Dueck
authors.forename: Nancy
authors.initials: N
authors.lastname: Olson
authors.forename: Pat
authors.initials: P
authors.lastname: Degagne
authors.forename: Selena
authors.initials: S
authors.lastname: Papetti
authors.forename: Alana
authors.initials: A
authors.lastname: Wald
authors.forename: Evelyn
authors.initials: E
authors.lastname: Lo
authors.forename: Godfrey
authors.initials: G
authors.lastname: Harding
mesh_terms: 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
chemical_list: D000891:Anti-Infective Agents, Local; D003470:Culture Media; D006861:Hydrogen Peroxide