Strategies to Prevent & Control C. difficile in Health Care Facilities—Part 1

When it comes to the fight against infectious diseases, many clinicians would agree that it’s better to prevent the infections from happening in the first place than finding effective ways of treating them afterward. Prevention is particularly important when it comes to addressing the urgent threat that is Clostridium difficile (C. diff).

At the 5th annual international C. diff Awareness Conference & Health Expo, in Las Vegas, Nevada, Contagion ^® sat down with Maureen Spencer, RN, BSN, MEd, CiC, FAPIC, director of clinical implementation at Accelerate Diagnostics, for an exclusive interview on her presentation of different strategies that can be used to prevent and control the transmission of the disease within health care facilities.

Contagion^®: What are some strategies that are currently being used to prevent C. diff in health care facilities?

Spencer: When a patient has 2 or more loose stools in a day, they should be put on special contact precautions—even while they’re waiting for C. diff [testing] results to come back. Two-thirds of feces are [comprised of] organisms; so, when you have somebody who’s got fecal incontinence, it requires a lot of material for the nurses to clean these patients up. [They are] emptying commodes, cleaning up feces; they don’t want their uniforms or their hands to get contaminated, so they want to use precautions. We implement what’s called special contact precautions because we can’t use the alcohol hand gel (it doesn’t kill C. diff) and so, handwashing [is needed]. That’s why you will see a sign outside the room that will highlight the fact that you need to do handwashing in that room. Nurses clean the rooms with bleach because C. diff is disinfected by bleach or a sporicidal agent; most of them will use bleach wipes and have the nurses clean high-touch surfaces and equipment before they go in and out of that room. Housekeeping will clean the floor, the bed, and the bathroom at discharge with a bleach solution.

Environmental disinfection is particularly important. Something as simple as using commode liners on all commodes [is also important]. I wouldn’t want any nurses to have to handle feces—even if it’s formed stool. That’s the problem with bathrooms in the intensive care unit (ICU): they have a toilet, and then they have an arm that comes down with a spray hose. Nurses will take the commode, if they don’t use a liner, pour the liquid feces into the toilet, spray hose it all over the environment, all over themselves, and flush it with no lid on the toilet, which sprays it 3 to 6 feet out of the toilet into the room. Getting hospitals to put lids back on the toilets, and nurses to use commode liners, can confine and contain the feces. In the emergency department and in the ICUs, all commodes should have a commode liner.

Contagion^®: Are there newer strategies being explored to prevent C. diff in facilities?

Spencer: We have very interesting technology available. One new technology that I just learned about is dried hydrogen peroxide which is a system that can be put up in your ventilation system. It will take the moisture that's in the air and turn it into hydrogen peroxide, continually disinfecting the room.

In addition, there are lights that run 24/7 with ultraviolet (UV) light that will disinfect the environment, even when you’re not in the room. In fact, they put on a higher level of disinfection activity when the room is vacated. There are all different types of UV robots, too. Most of them work similarly, but there’s one that I prefer that has sensors on the floor because we know that the floor can be a source of cross-contamination. These sensors can ensure that your environmental services (EVS) worker got the right amount of UV to kill C. diff spores. That is something valuable from a quality control point-of-view rather than what an infection preventionist might look at—built-in quality control with software that can monitor treatments of the room.

There are also some newer innovative products for cleaning that might not be bleach-based but rather sporicidal for environmental cleaning. For example, Sherwin-Williams has paint that can have an antibacterial effect and will kill bacteria on the wall. There are a lot out of new innovative products out there.”

Stay tuned for Part 2 of the Q & A, which will touch on challenges to disinfecting hospital rooms.

Editor’s note: Parts of this audio-recorded interview have been modified slightly for readability.