Environmental contamination plays a larger role than previously recognized, prompting calls for updated infection control strategies
Infection control practice
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A study published in JAMA Network Open has identified previously unrecognized pathways through which Clostridioides difficile spreads in healthcare settings. While direct patient-to-patient transmission has long been considered the primary mode of infection, researchers found that C difficile also persists on hospital surfaces, contributing to delayed and indirect transmission between patients. These findings suggest a need for revised infection prevention strategies to account for environmental reservoirs.1
Researchers at the University of Utah conducted a genomic analysis of C difficile isolates collected from nearly 200 intensive care unit (ICU) patients, healthcare providers' hands, and hospital surfaces. Whole-genome sequencing was used to track transmission events, revealing that C difficile frequently survived in the environment and spread to patients who had no direct contact with an infected individual.1
More than half of the transmission events identified in the study involved patients admitted at different times, suggesting that C difficile can persist in hospital environments for extended periods. The genetic similarity of strains isolated from surfaces and later-infected patients supports the hypothesis that environmental contamination serves as a major, underrecognized reservoir for transmission.1
Current infection control strategies emphasize hand hygiene and alcohol-based sanitizers, but these measures may be insufficient given the resilience of C difficile spores. Study co-author Lindsey Keegan, PhD, a research associate professor of epidemiology at the University of Utah, noted that while patient-to-patient transmission rates were consistent with prior studies, the extent of environmental transmission was higher than previously reported.1
To mitigate the risk of environmental transmission, the researchers recommend:1
Genomic sequencing shows C difficile frequently spreads via hospital surfaces, not just direct patient contact.
Alcohol-based sanitizers are ineffective against C difficile spores, highlighting the need for soap-and-water handwashing and sporicidal cleaning.
The findings support and expand on CDC guidelines urging comprehensive infection control that addresses environmental reservoirs.
This study, underscoring the environmental transmission of C difficile in hospitals, aligns with existing CDC guidance on preventing CDI in acute care settings. The CDC emphasizes five core strategies: prompt isolation and contact precautions for suspected or confirmed cases, laboratory confirmation of infection, thorough environmental cleaning with sporicidal agents, development of infrastructure to support prevention efforts, and engagement of antimicrobial stewardship programs. These strategies aim to address both direct and indirect transmission pathways, such as contaminated surfaces highlighted by the new genomic research.2 Together, these findings and guidelines reinforce the need for hospitals to go beyond standard protocols and adopt comprehensive, environment-focused infection control practices.
In other recent related news, Lumen Bioscience’s investigational oral biologic, LMN-201, achieved a 100% initial clinical cure rate for CDI in a preliminary cohort of its RePreve trial. The therapy, taken alongside standard antibiotics, was safe, well-tolerated, and showed lower recurrence than existing treatments. These early results support LMN-201’s novel dual-target approach neutralizing C difficile bacteria and its toxin and suggest promise for reducing relapse in high-risk patients.3
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