Read Part 1 of this blog post here.
Preventing C. Difficile Infection: 4 Critical Strategies
Infection-control experts agree: containing CDI is an urgent global priority, given the emergence of more potent C. difficile strains and the ageing of the developed world’s population.
However, no single strategy will suffice. Following are four approaches that, in combination, can dramatically reduce the spread of C. difficile at hospitals and nursing homes.
More judicious use of antibiotics
Antibiotic overuse is a major cause of CDI, as well as its recurrence. Antibiotics can disturb the normal intestinal flora for several months, wiping out “good” bacteria that protect patients against infection such as CDI.
Among nursing-home patients with CDI, 75% had recent antibiotic exposure and 76% had recently been discharged from a hospital, according to the U.S. Centers for Disease Control and Prevention (CDC).
An estimated 30% to 50% of all antibiotic use is considered unnecessary, says the CDC. Reducing broad-spectrum antibiotic use by 30 percent could lower CDI by 26 percent.
“To make headway against CDI, hospitals and health facilities need to get serious about antibiotic stewardship,” said Jennie Mayfield, M.D., past president of the Association for Professionals in Infection Control and Epidemiology.
Better hand-hygiene compliance
Hospitals and nursing homes also need to get more serious about hand hygiene.
A French study, for example, found that 24% of healthcare workers’ hands were contaminated with C. difficile spores after routine care of CDI patients. Washing patients, administering a digital rectal exam or colonoscopy, changing bed linens — all were linked with C. diff. transmission.
Adding to the challenge, C. difficile spores are notoriously resistant to disinfection. Alcohol-based hand rub kills the bacteria but not the spores, so hygiene experts emphasize using soap and water. But even then, the spores are more difficult to remove than other common pathogens.
Wearing gloves when caring for infected patients is essential — yet also inadequate. “Glove use is not an absolute barrier against the contamination of healthcare workers’ hands,” noted the lead author of the French study.
Education and incentives can improve hand hygiene, but only to a point. Compliance remains “abysmally low,” according to the World Health Organization. In fact, 76% of healthcare workers miss at least one key moment among WHO’s “Five Moments for Hand Hygiene,” a European research team found.
According to Swiss researchers, the hands of doctors and nurses deposit – and likely transmit – potentially harmful microbes every 4 seconds onto patients and hospital surfaces.
More thorough surface cleaning
Hospital surface cleaning is notoriously hard; cleaning surfaces contaminated with C. difficile is even harder.
C. difficile spores are impervious to many disinfectants commonly used in hospitals; in fact, some hospital cleaning detergents may actually encourage spore production.
What’s more, disinfectants shown to be effective — such as sodium hypochlorite in high concentrations — can corrode equipment over time and trigger respiratory difficulties among cleaning staff.
Cleaning protocols for C. difficile must be followed meticulously, yet this rarely happens.
In hospital wards and intensive care units, research shows, C. difficile contamination has been found on 49% of sites in rooms occupied by patients with CDI and on 29% of sites in rooms occupied by asymptomatic carriers.
The heaviest contamination is found on floors and bedrails but other commonly contaminated areas include windowsills, toilets, bedsheets, call buttons, scales, blood pressure cuffs, electronic thermometers, flow-control devices for intravenous catheters, and feeding-tube equipment.
The fact is, hospital cleaners are often overworked and undertrained, so cleaning tends to be subpar.
“Because of unfortunate staffing deficiencies faced by some hospitals today,” an American research team concluded, “workers from the environmental services department may mistakenly alter vitally important cleaning practices.”
Given how easily C. difficile is spread — via contaminated surfaces, hands, and air — infection-control experts recommend CDI patients be isolated in single-occupancy rooms. But this practice is simply not feasible in many regions.
That’s one reason hospitals and nursing homes must take all possible precautions, including air disinfection.
Technology by Novaerus has been shown to reduce C. difficile by 99.6% after 20 minutes — and by 99.9% after 40 minutes.
Novaerus units have the benefit of operating 24 hours a day, without any effort or training on the part of healthcare workers or hospital cleaners. And unlike surface cleaning chemicals, these units pose no risk to hospital personnel or patients.
Installing Novaerus technology is a proven way for healthcare facilities to add a layer of protection against C. difficile and numerous other pathogens — a critical strategy in the superbug era.