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Hospitals adopting 'wrong' C difficile strategies

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Nurses may in future need to re-think infection control procedures in light of research that challenges common assumptions about how Clostridium difficile is spread.

Latest study findings contradict “prevailing beliefs” that most cases of C difficile are transmitted round wards between patients, which the authors say raises “concern about other acquisition routes”.

Researchers from John Radcliffe Hospital in Oxford found only around a quarter of C difficile cases were the result of direct contact between patients on a ward.

They tested stool samples from almost 15,000 hospital patients and found evidence of C difficile in 4.4%. Further tests found only 23% of patients had been infected with the same strain of C difficile as another patient on the same ward, with the majority, 66%, not linked to known cases.

The authors said: “The 25% of cases linked via ward contact represent a major hospital-acquired infection problem; however, the remaining 75% of unexplained transmission raises concern about other acquisition routes not captured by this study.”

They suggest other transmission routes might include asymptomatic carriers, such as relatives and hospital staff, or “significant acquisition within the community” before admission, for example from food or animals.

“Crucially, these findings mean that C difficile infection might not be effectively controlled by current strategies to prevent person-to-person spread,” the researchers said in the journal Public Library of Science.

“A better understanding of other routes of transmission and reservoirs is needed to determine what other types of control interventions are required to reduce the spread of C. difficile,” they add.

Infection Prevention Society president Tracey Cooper told Nursing Times the study was an “important step forward in understanding the epidemiology of Clostridium difficile infection”.

But she added: “It does show that a not insignificant proportion of cases may still be due to cross-infection.

“It is therefore vital that all healthcare staff implement best practice for hand hygiene, cleanliness, antimicrobial prescribing, and isolation of patients with diarrhoea, in order to protect their patients.” 

In 2007-08, a total of 55,498 C. diff cases were reported in England. Between 2008-09 there were 36,095 reported cases, a decrease of 35%.

 

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Readers' comments (2)

  • have a look at the C Diff Cycle diagram on Infection Protection.Org website.

    Why is it a surprise that transmission is not always by direct contact?
    Wake up NHS!

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  • C. difficile transmission relies on the shedding of highly resistant spores in the faeces of humans. These bacterial spores are essentially dormant cells with protective outer layers making them well-adapted for survival and dispersal in a wide range of environmental conditions. When humans shed spores in their faeces, those spores are capable of surviving dormant in the environment for long periods of time, under harsh conditions and in temperatures up to 70 ºC, before reintroduction and infection in a new human host.
    It is obvious that anyone carrying C Diff even without symptoms could be responsible for transmission and that without meticulous hygiene in wards or in the community could unknowingly pass on the infection or contaminate any environment. Have a look at eh C Diff section on the Infection Protection.Org website.

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