Control of nosocomial transmission of Clostridium difficile based on sporadic case surveillance

• Published in: The American journal of medicine Vol. 91; no. 3B; p. 138S
• Main Authors: Struelens, M J, Maas, A, Nonhoff, C, Deplano, A, Rost, F, Serruys, E, Delmee, M
• Format: Journal Article
• Language: English
• Published: United States 16-09-1991
• Subjects: Adolescent; Adult; Aged; Aged, 80 and over; Belgium - epidemiology; Child; Clostridium difficile; Clostridium Infections - diagnosis; Clostridium Infections - epidemiology; Clostridium Infections - prevention & control; Cross Infection - diagnosis; Cross Infection - epidemiology; Cross Infection - prevention & control; Disease Outbreaks; Enterocolitis, Pseudomembranous - epidemiology; Enterocolitis, Pseudomembranous - prevention & control; Enterocolitis, Pseudomembranous - transmission; Female; Humans; Infection Control; Male; Middle Aged; Belgium
• ISSN: 0002-9343
• DOI: 10.1016/0002-9343(91)90359-6

The recognition of a cluster of antibiotic-associated nosocomial Clostridium difficile disease (NCDD) caused by serotype C in a surgical ward led to a hospital-wide NCDD surveillance and control program. The initial step included: (a) gas-liquid chromatography screening of inpatients' diarrheal stools; (b) enteric isolation precautions, cohorting and terminal room disinfection in wards with a cluster of two or more NCDD cases per month. During a 12-month period, the quarterly incidence of NCDD remained unchanged and six new clusters of serotype C, K, and H infections occurred, giving a global incidence of 1.5/1,000 admissions. C. difficile spores were recovered from 36.7% surfaces of case patient rooms versus 6.7% in control rooms. More intensive control measures were evaluated: (a) culture screening of inpatients' diarrheal stools; (b) early therapy, enteric isolation precautions, and daily meticulous room disinfection for each sporadic NCDD case. Surface disinfection reduced the contamination level four-fold (p = 0.04). In the following 12 months, no cluster occurred and the incidence of NCDD fell to 0.3/1,000 admission (protective efficacy 73%, 95% confidence interval: 46-87%). These observations suggest that early therapy, isolation precautions, and surface disinfection, focused on patients with sporadic NCDD detected by active surveillance, can prevent nosocomial transmission of C. difficile.