Tackling C. diff

Here’s a troubling statistic: Over 165,000 patients will acquire Clostridium difficile (“C. diff’) infections while in US hospitals this year. This organism has become a top hospital-acquired pathogen in the US.

“Clostridium difficile,” is a spore-forming bacterium that can live in the lower gastrointestinal tract of some humans and is shed in feces. Persons hosting C. diff may have no symptoms and be unaware that they are contagious. Other persons will become infected under specific circumstances. A C. diff infection may produce watery diarrhea, fever, loss of appetite, nausea or abdominal pain and tenderness. According to the Centers for Disease Control and Prevention (CDC), patients who are at increased risk for infection include those who:

• are taking antibiotics
• have had gastrointestinal procedures
• have had a prolonged stay in a healthcare institution
• have a serious underlying illness
• are of an advanced age.

Any surface or medical device that becomes contaminated with feces may serve as a reservoir for C. diff spores including toilets, bathtubs, or electronic rectal thermometers. In the healthcare setting, the spores are thought to be transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item. Dr. Robert Orenstein, of the Mayo Clinic Arizona, calls C. diff infection “a significant threat to our public health”. His goal is to reduce the risk of C. diff infection by reducing environmental contamination and he has a strategy that just might work.

A Tale of Two Hospital Units

In a 2011 publication Dr. Orenstein describes a study in which two high-risk hospital units were targeted for daily cleaning of high touch surfaces with germicidal bleach wipes (in addition to terminal cleaning after a patient is dismissed). The researcher chose bleach wipes because a 10 percent solution of hypochlorite bleach destroys the spore form of C. diff. The study showed that over a six-month period the units experienced a 92 percent decline in hospital-acquired C. diff infection! This result was achieved without any other interventions, such as increased attention to hand hygiene. Further, Dr. Orenstein reports, the results were sustained for over one year with only two infections in 12 months. Meanwhile, infection rates in other units in the study hospital remain high.

To implement these effective risk reduction measures, environmental service staff were trained in proper use of bleach wipes. Housekeepers worried about the irritating effects of bleach were given plain surgical masks and ventilation was ensured. As the study progressed, patient and employee tolerance of the wipes was monitored and found to be satisfactory. Orenstein notes no reports of equipment damage; keyboard covers, however, “often had a haze after the product dried on them.” A wet cloth applied to the covers removed the haze, which is a salt residue.

Dr. Orenstein’s study provides importance evidence to help destroy C. diff—a significant hospital public enemy found on surfaces in healthcare settings. Healthcare officials should consider adopting a bleach disinfection strategy for daily and terminal cleaning, a step that could help decrease the risk of serious infection.

Barbara M. Soule, R.N. MPA, CIC, is an Infection Preventionist and a member of the Water Quality & Health Council.