Regular Article
Prospective evaluation of environmental contamination by Clostridium difficile in isolation side rooms

https://doi.org/10.1053/jhin.2001.1078Get rights and content

Abstract

We determined prospectively the frequency, persistence and molecular epidemiology of Clostridium difficile environmental contamination after detergent-based cleaning in side rooms used to isolate patients with C. difficile diarrhoea. Approximately one-quarter of all environmental sites in side rooms sampled over four-week periods were contaminated with C. difficile. The overall side room prevalence of environmental C. difficile declined from 35% initially, to 24% in week 2, 18% in week 3, and 16% in week 4. The bed frame was the most common site from which C. difficile was recovered, although the floor was the most contaminated site in terms of total numbers of colonies. C. difficile was recovered significantly more frequently from swabs plated directly on to C. difficile selective media containing lysozyme than from enrichment broth (P< 0.001), emphasizing the benefit of lysozyme supplementation. The great majority of C. difficile isolates (87% of all isolates, 84% of patient isolates) was indistinguishable from the UK epidemic strain (PCR ribotype 1). It thus could not be determined whether environmental contamination was a cause or a consequence of diarrhoea. Our findings highlight the need for improved approaches to hospital environmental hygiene, and call into question current UK guidelines that recommend detergent-based cleaning to remove environmental C. difficile. In particular, improved cleaning of frequently touched sites in the immediate bed space area is required.

References (30)

  • M Wilcox et al.

    Role of antibody response in outcome of antibiotic-associated diarrhoea

    Lancet

    (2001)
  • Commun Dis Rep CDR Weekly

    (2000)
  • TV Riley

    Clostridium difficile: a pathogen of the nineties

    Eur J Clin Microbiol Infect Dis

    (1998)
  • A Anand et al.

    Epidemiology, clinical manifestations, and outcome of Clostridium difficile diarrhoea

    Am J Gastroenterol

    (1994)
  • CD Settle et al.

    Prospective study of the risk of Clostridium difficile diarrhoea in elderly patients following treatment with cefotaxime or piperacillin-tazobactam

    Alimentary Pharmacology & Therapeutics

    (1998)
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    Author for correspondence: Dr M. H. Wilcox, Department of Microbiology, University of Leeds, Leeds LS2 9JT, UK. Tel: +44 113 233 5596; Fax: +44 113 233 5649; E-mail:[email protected]

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