Much of the emphasis on risk reduction was really an emphasis on reducing unnecessary testing and false-positive test results-known as Test Stewardship. This is the low hanging fruit and not truly infection prevention.
The CDC Compendium of Strategies to prevent C. difficile highlights key interventions for risk reduction. This paper, recently published in Clinical Infectious Diseases, used modeling to asses both patient centered and hospital centered interventions and highlights the efficacy of a 2 intervention bundle: daily use of a sporicidal agent and C. difficile screening on admission. Together, the bundles decreased hospital onset C. difficile by 82% and asymptomatic hospital onset colonization by 90%.
UVC light disinfect also reduces VRE and C. difficile infections as summarized here by Dr. Alexandre Marra and colleagues and by us in this invited review article.
However, diverse sources of C. difficile have been reported, suggesting that most hospital onset cases are not hospital acquired. Colonization sources are diverse with disease later precipitated by antibiotic use, so the importance of antimicrobial stewardship cannot be overlooked.
We follow the CDC compendium strategies, universally use sporicidal agents for daily and terminal disinfection, deploy UVC Robots, have a robust antimicrobial stewardship program and have recently implemented an EMR based C. difficile PCR decision support to minimize over testing (test stewardship).
As for active detection and isolation of C. difficile, we have yet to pull the trigger.
The prevention of C. difficile is complicated and multifaceted, not like the more linear approach taken for the prevention of device associated infections (CLABSI, CAUTI, VAP etc), where the presence of the invasive device is the driving risk factor.
We need acknowledge the limitations to better understand the outcomes of C. difficile prevention.
Keep it real.
