Searching for C. difficile at Hospital Admission: A Commentary in JAMA Internal Medicine

Posted on by CDC's Safe Healthcare Blog
Clifford McDonald, MD
Clifford McDonald, MD

Author: L. Clifford McDonald, MD
Associate Director for Science,
CDC Division of Healthcare Quality Promotion

Patients receiving medical care for something else can get an infection known as a healthcare-associated infection. The most common bacteria responsible for these infections in hospitals is Clostridium difficile (C. difficile). In a recent issue of JAMA Internal Medicine, my CDC colleague Alice Y. Guh, MD, MPH, and I have offered commentary on a study that investigated whether actively identifying and isolating patients who asymptomatically carry C. difficile (do not experience symptoms) can reduce the number of healthcare-associated C. difficile infections.

C. difficile can be spread in healthcare facilities between patients by contaminated surfaces and soiled hands when appropriate hygiene and infection control actions are not taken. Currently limiting spread of C. difficile in healthcare facilities involves infection control targeting patients with symptoms, such as isolating these patients in individual rooms. However, there is now increasing evidence that patients who carry C. difficile without symptoms can contribute to contamination and spread in healthcare facilities. Still few, if any, previous studies have demonstrated whether searching for asymptomatic carriers of C. difficile, and then isolating them, can further limit transmission and prevent infections.

The study found that detecting and isolating C. difficile carriers at the time of hospital admission was associated with a significant decrease in the incidence of healthcare-associated C. difficile infections. However, because there are inherent limitations in any single study on such a complex topic, the authors of this study called for additional studies to further investigate this strategy, a call we agree with in our commentary. Our commentary touches on additional factors that future studies should focus upon, including assessing the feasibility and challenges of routinely implementing active surveillance for C. difficile.

C. difficile was estimated to cause almost half a million infections in the United States in 2011. The results of this study are promising for not only increasing our understanding of how this organism is spread in healthcare facilities, but also casting light on potential supplemental measures to reduce healthcare-associated C. difficile infections. While we continue to further investigate this topic, it’s important to remember that even with what we know already, many C. difficile infections can be prevented by using current infection control recommendations and more careful antibiotic use. Visit CDC’s C. difficile website to find resources for patients and healthcare providers.

To access and read the commentary, visit the JAMA Internal Medicine website.

Posted on by CDC's Safe Healthcare Blog

6 comments on “Searching for C. difficile at Hospital Admission: A Commentary in JAMA Internal Medicine”

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    We published one study made in Mexico City with pediatric patient with and without antibiotic treatment. I don’t remember the year

    I would also like to know more about Mrsa, especially Hospital acquired. I unfortunately picked it up while having a knee replaced. I only showed one small infection on the same leg. It was aprox. 10 inches from my surgery. The Dr. prescribed a medicine and it went away. I also had my other knee replaced last year (I was Isolated) Everything was fine and I never got another infection. My Dr said I still show Mrsa in my nose but other than that, nothing. Is the new Government monies going to try and find a clear for MRSA too? I am on pins and needles hoping I don’t sneeze or somehow give it to someone. Any info that would be helpful, would be appreciated. Everyone says the Pharma Co. aren’t that concerned because there is no money in finding a cure for C. Diff and Mrsa. Thank You, Laurence. (Ps. I also have CLL and it is in remission since Chemo, it occurred before the Mrsa and Knee replacements)

    Do hospitals need to be testing solid stools for the antigen, Currently we only do loose stools, but they can still be carriers if the stool is solid, right? Can you shed some light on this question for us?

    Thanks

    This is a very interesting perspective on CD prevention. Very ‘vertical’ as opposed to a more holistic or horizontal prevention strategy (Wenzel et al. Screening for MRSA: A flawed hospital infection control strategy ICHE 2008;29:1012-18). If this hospital is unfortunate enough to have a patient with CRE or ESBL arrive, with transmission to other patients, will they then add this to the screening list? Of course, Boyce et al (J Clin Micro 2005;43(12):5992-5) found patients on screening carrying high numbers of MRSA. Should we add this to the screening list, along with VRE, Acinetobacter, etc.? I am not being flippant, I have concerns that we are losing sight of how we handle feces in healthcare and perform standard precautions. Nowhere in the Longtin article is it discussed how the patients toilet: are they continent and able to perform their own peri-care? Are they continent but need assistance to the toilet and off? Do they use a commode alone or with assistance? Do they wear a brief/diaper? How are bedpans/commode buckets handled within the facility? Are they reprocessed within the patient room (a common practice), placed in a thermal disinfection machine, macerated, lined with a disposable liner with absorbent pad? I think we need to add this to our articles and research into organism transfer that involves feces, as all spread of fecal-oral organisms indicates issues with environmental soiling. I think we need barriers for any potential contact with feces, whether the feces has marker organisms (CD, ESBL, CRE, VRE, MRSA) or not, as there are still numerous other organisms that could cause other patients problems if there is a mode of transmission or portal of entry into a susceptible host. We need much more focus on patient hand hygiene, auditing environmental cleaning, use of effective cleaning and disinfecting products, antibiotic stewardship and good education on all components of infection prevention.

    It is intriguing how C diff presents in different population. It is well accepted that overuse of antibiotics is the main culprit but can not stop thinking why doctors in some Latin American countries don’t see near to the levels that we see here in the US. Anyone can get antibiotics from local pharmacies without prescription and many people delft treat themselves yet they don’t seem to get C diff infections. Any thoughts ?

    We place our patient with C. diff on transmission precautions for 30 days or the entire inpatient admission if they are here longer than 30 days. However, what we would love is some study or guidance regarding readmissions after the 30 days. How many weeks/months after the positive lab test, should we consider implementing transmission precautions on readmitted patients who were recently positive but are now readmitted without symptoms? If a patient is readmitted within the 30 day period, we place them on transmission precautions, but if they are admitted 45 days later and are asymptomatic, are they a potential source transmission requiring precautions?

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Page last reviewed: November 18, 2016
Page last updated: November 18, 2016