Don’t Forget C. Diff

Clostridioides difficile (C. diff) infection remains the leading cause of antibiotic- and healthcare-associated infective diarrhea in the United States, according to the U.S. Centers for Disease Control and Prevention (CDC). It affects approximately half a million patients annually in the U.S.; around 30,000 die as a result of their infection. 

Hospitals and health systems have made considerable progress in decreasing the number of C diff infections in recent years. In fact, healthcare-acquired C. diff infections have gone down  even as other healthcare-associated infections (HAIs) have increased. The total burden of healthcare-associated C. diff infections declined by 36% from 2011 to 2017, according to a 2023 BMJ Infectious Diseases article. The CDC also reports a 3% decrease in hospital-onset C. difficile infections between 2020 and 2021, which is particularly remarkable because most HAIs increased during the COVID-19 pandemic. 

Focusing all of your attention on other infectious agents, though, is not a good idea. According to the CDC, community-associated C. diff infections – infections contracted in the community, rather than in healthcare settings – nearly doubled over the past decade. You may have patients entering your facility with undetected C. diff infections – and without intervention, those infections could spread to other patients and staff, affecting both your bottom line and staff availability. 

Don’t neglect C. diff in your HAI-prevention effects. Use these four strategies to mitigate and control C. difficile infections: 

1. Isolate & institute contact precautions for patients with diarrhea or suspected C. diff exposure or infection

It’s best to err on the side of caution. The CDC says hospitals should “create nurse-driven protocols to facilitate rapid isolation of patients with suspected or confirmed” C. diff infection. Given the uptick in community-acquired infections, it’s prudent to ask all patients upon admission if they currently have diarrhea or have recently been around someone with diarrhea or suspected or confirmed C. diff

All patients with diarrhea or suspected C. diff exposure should be isolated until the root cause of the diarrhea is confirmed and C. diff has been ruled out. Patients should be in a single-patient room with a dedicated toilet. 

Be sure that shared blood pressure cuffs, stethoscopes, thermometers and other patient care equipment are not used on patients with diarrhea or suspected or confirmed C. diff. Instead, dedicate specific equipment for their use. When patients must travel to another part of the hospital, maintain contact precautions. 

Use soap and water to cleanse patients daily. Alcohol-based sanitizers do not kill C. diff spores. Bathing patients with soap and water may decrease C. diff load and minimize the amount of infectious material in the room. 

If a case of C. diff is confirmed, the SwipeSense Contact Tracing application makes it easy to quickly determine who may have been exposed, so exposed staff members and patients can be isolated, tested, and, if necessary, treated to prevent the spread of infection. 

2. Use gloves to prevent hand contamination & perform hand hygiene with soap & water

All healthcare staff should wear gloves and a gown when treating, interacting with, or working in rooms occupied by patients with confirmed or suspected C. diff, according to the CDC. Gloves are necessary because no single method of hand hygiene will eliminate all C. diff spores, so minimizing exposure is imperative.

Appropriate hand hygiene before and after donning and doffing gloves is essential. Proper removal of gloves decreases, but doesn’t eliminate the possibility of hand contamination, so staff must also clean hands with soap and water after glove removal. Alcohol-based hand sanitizer does not kill C. diff spores, so soap-and-water cleansing is vital. SwipeSense's EMR integration can automatically trigger the automatic voice reminder to remind clinicians and visitors to “use soap and water only” when cleansing hands in rooms occupied by a patient with confirmed C. diff

3. Use antibiotics judiciously

The most significant risk factor for C. diff infection is antibiotic usage. Careful use of antibiotics can decrease C. difficile infections both within hospitals and communities.

According to the CDC, “30 to 50% of antibiotics prescribed in hospitals are unnecessary or incorrect.” Hospitals should implement the 7 Core Elements of Hospital Antibiotic Stewardship, carefully evaluate the need to prescribe antibiotics that present the highest risk for C. diff infection (fluroquinolones, carbapenems, and 3rd and 4th generation cephalosporins), and ensure patients receive the shortest effective duration of antibiotic therapy. 

4. Institute environment cleaning protocols with a C. difficile sporicidal agent

The CDC has long recommended use of C. diff-killing cleaning agents to sanitize rooms and equipment used by patients with C. diff. Recent research suggests that using sporicidal cleaning agents hospital wide may be the best way to effectively decrease C. diff infections. 

According to a 2023 article in Infection Control and Hospital Epidemiology, when eight hospitals of varying sizes instituted a program of daily hospital-wide cleaning with C. diff sporicidal disinfectant, the hospitals experienced a sustained 50% reduction in hospital-acquired C. diff infections compared to peer hospitals that did not institute daily sporicidal cleaning. The researchers concluded that “even sites with low endemic rates” of healthcare-onset C. diff “could benefit from a program that includes hospital-wide daily sporicidal disinfection cleaning…”

As C. diff increases in the community, it will take continued vigilance to keep C. diff levels low in hospital settings. Prompt isolation and contact precautions, appropriate glove use and hand hygiene, judicious use of antibiotics, and hospital-wide use of sporicidal cleaning agents will help you control C. diff