Monday, March 6, 2017

Prevention of C. difficile Infection In The Hospital- Challenging Orthodoxy

I personally think that is very exciting when new data challenges our practice in infection prevention.

In 2013, Eyre and colleagues published a paper in the New England Journal of Medicine demonstrating, by whole genome sequencing, that slightly more than a third of C. difficile infections were transmitted from symptomatic patients. Most infectious were likely not hospital acquired and emerged from diverse (non-hospital) reservoirs. 

More recently, Widmer and colleagues have challenged the use of contact precautions (standard of care) for the control of C. difficile.  In a very recent publication, contact precautions for C. difficile were discontinued except for patients with hypervirulent strains or fecal incontinence. After 10 years, no outbreaks were observed and the transmission rate was 1.3%, very low. Robust hand hygiene and single occupancy rooms likely played a large roll in limiting transmission. 

These may be the beginning of a paradigm shift, with greater emphasis on higher value interventions to limit the risk of C. difficile in the hospital. First, most cases may not be hospital acquired. Aggressive use of contact precautions may not be the answer. Good hand hygiene and minimizing the use on unnecessary antibiotics, which significantly predisposes to clinical C. difficile disease, may be the first approach. Improved disinfection (with bleach, UVC light) may help, however, the impact may not be as great as expected.

I will be at the SHEA 2017 Spring Conference, formally debating and discussing C. difficile control strategies with my esteemed colleagues Drs. Silvia Munoz-Price and Michael Edmond.

I am looking forward to it and plan to learn a lot.

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