title: Infection prevention and control ofClostridium difficile:a global review of guidelines, strategies, and recommendations.
abstract: BACKGROUND
  Clostridium difficileis the leading cause of health care-associated infections. Given the high incidence ofC. difficileinfection (CDI) and the lack of primary prevention through immunization, health care professionals should be aware of the most current guidance, as well as strengths and limitations of the evidence base underpinning this guidance.
  
  
  METHODS
  We identified publicly available national or organizational guidelines related to CDI infection and prevention control (IPC) published between 2000 and 2015 and for any health care setting through an internet search using the Google search engine. We reviewed CDI-targeted IPC recommendations and describe the assessment of evidence in available guidelines.
  
  
  RESULTS
  We identified documents from 28 countries/territories, mainly from acute care hospitals in North America, the Western Pacific, and Europe (18 countries). We identified only a few specific recommendations for long-term care facilities (LTCFs) and from countries in South America (Uruguay and Chile), South East Asia (Thailand), and none for Africa or Eastern Mediterranean. Of 10 IPC areas, antimicrobial stewardship was universally recognized as essential and supported by high quality evidence. Five other widely reported "strong" recommendations were: effective environment cleaning (including medical equipment), case isolation, use of personal protective equipment, surveillance, and education. Several unresolved and emerging issues were documented and currently available evidence was classified mainly as of mixed quality.
  
  
  CONCLUSIONS
  Our review underlines the need for targeted CDI IPC guidelines in several countries and for LTCFs. International harmonisation on the assessment of the evidence for best practices is needed as well as more robust evidence to support targeted recommendations.
authors.affiliation: Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland (UK).
authors.forename: Evelyn
authors.initials: E
authors.lastname: Balsells
authors.affiliation: Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland (UK).
authors.forename: Teodora
authors.initials: T
authors.lastname: Filipescu
authors.affiliation: Sanofi Pasteur, Swiftwater, PA, USA.
authors.forename: Moe H
authors.initials: MH
authors.lastname: Kyaw
authors.affiliation: Health Protection Scotland, Scotland, UK.
authors.forename: Camilla
authors.initials: C
authors.lastname: Wiuff
authors.affiliation: Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland (UK); Joint last authorship.
authors.forename: Harry
authors.initials: H
authors.lastname: Campbell
authors.affiliation: Centre for Global Health Research, Usher Institute of Population Health Sciences and Informatics, University of Edinburgh, Edinburgh, Scotland (UK); Public Health Foundation of India, New Delhi, India; Joint last authorship.
authors.forename: Harish
authors.initials: H
authors.lastname: Nair
mesh_terms: D016360:Clostridioides difficile / Q000302:isolation & purification; D003015:Clostridium Infections / Q000382:microbiology / Q000517:prevention & control*; D003428:Cross Infection / Q000382:microbiology / Q000517:prevention & control*; D019317:Evidence-Based Medicine; D014943:Global Health; D006801:Humans; D017053:Infection Control / Q000379:methods*; D017410:Practice Guidelines as Topic