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Preventing Clostridium difficile infection

Clostridium difficile Initiative

The Clostridium difficile initiative works to assess, identify gaps, and prevent transmission of C. difficile infection (CDI) across different healthcare settings. We focus on 5 key domains to prevent infection and transmission of CDI and other multidrug-resistant organisms (MDROs):

  1. Surveillance: Enroll facilities into the National Safety Network for Reporting
  2. Best infection control practices: Identify opportunities to prevent transmission based on the facility's needs
  3. Environmental hygiene: Implement or improve existing housekeeping and disinfection practices using observations and feedback
  4. Antibiotic stewardship: Favor judicious use of antibiotics for common problems like asymptomatic bacteriuria
  5. Interfacility transfer communication: Establish or strengthen facility communication about MDRO, CDI or other illnesses.

Basic Definitions

What is C. difficile?

Clostridium difficile is a bacteria that can cause diarrhea, abdominal pain, fever, bowel inflammation (colitis), and rarely severe colitis (“pseudomembranous colitis”) and bowel perforation. In its spore (inert) form, it survives heat and frost in the environment; C. difficile spores usually pass through our guts without harm. However, certain triggers, such as antibiotics or proton pump inhibitors, cause C. difficile to grow and produce toxins. These toxins cause the symptoms of diarrhea.

How is C. difficile spread?

C. difficile spores are spread on hands of sick patients and healthcare workers, and from surfaces and rooms that are not properly cleaned. Spores are not killed with typical disinfectants; so you need to use a fresh bleach solution (1:10 dilution) or special disinfectants. (EPA List K).

What is “healthcare-associated” C. difficile infection?

In an effort to address the causes of C. difficile infection (CDI), infections have been attributed to “healthcare-associated” vs. “community-associated.” Healthcare-associated C. difficile infections occur within 12 weeks of documented admission to a healthcare facility (e.g., hospital, nursing home, etc.); they account for 66% of CDI. These are further divided into healthcare- or community-onset, depending on where and when the person began having symptoms. Healthcare-associated cases are about evenly divided between hospital-onset, nursing home-onset, and other community-onset.

What is “community-associated” C. difficile infection?

C. difficile infections that occur without a history of admission to a healthcare facility in the last 12 weeks are considered community-associated, and account for about 33% of CDI.




Control Measures