From the Guidelines
Isolation precautions for C. difficile (C. diff) require contact precautions with a private room and dedicated equipment, and these precautions should continue until the patient has been diarrhea-free for at least 48 hours, as recommended by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA) 1. To prevent the transmission of C. diff, healthcare workers must wear gloves and gowns when entering the patient's room and remove them properly before exiting, as emphasized by the clinical practice guidelines for Clostridium difficile infection in adults and children 1. Some key points to consider when implementing isolation precautions for C. diff include:
- Hand hygiene should be performed with soap and water rather than alcohol-based hand sanitizers, as C. diff spores are resistant to alcohol 1.
- The patient's room requires thorough cleaning with sporicidal agents such as bleach-based disinfectants 1.
- Visitors should also follow these precautions when entering the room to prevent transmission.
- Patients with CDI should be accommodated in a private room with a dedicated toilet to decrease transmission to other patients, and if cohorting is required, patients infected or colonized with the same organism(s) should be cohorted together 1. These strict measures are necessary because C. diff is highly transmissible through spores that can survive on surfaces for months and are resistant to many standard cleaning agents, and proper isolation prevents transmission to other patients and healthcare workers, reducing the risk of outbreaks in healthcare settings 1.
From the Research
Isolation Precautions for C. difficile
- C. difficile is a major cause of morbidity and mortality in the intensive care unit, and therefore, guidelines are frequently being updated 2
- The infection is particularly problematic as a hospital-acquired infection, causing significant costs to the healthcare system 3
- Transmission of C. difficile occurs by the fecal-oral route, and the most important risk factors include antibiotic therapy, old age, and hospital or nursing home stay 4
Prevention and Control Measures
- Antibiotic stewardship and infection control measures will remain essential components for C. difficile management 5
- Validated risk prediction tools are needed to identify patients most likely to benefit from treatments 5
- Future advancements in microbiota targeting treatments will emerge as promising alternatives to standard C. difficile treatments 5
Treatment Options
- Vancomycin or fidaxomicin are now recommended for first-line therapy for most cases of C. difficile infection 6, 5
- Fecal microbiota transplant is effective and safe for the treatment of recurrent C. difficile infection 6, 5
- Bezlotoxumab is suggested in recurrent cases within 6 months 2
- Metronidazole is associated with lower rates of treatment success compared to vancomycin and should no longer be used as primary therapy for the first episode of C. difficile or recurrent disease 5