Discontinuation of C. diff Precautions
Continue contact precautions for at least 48 hours after diarrhea has resolved 1. This means the patient needs to have formed stools (no diarrhea) for a minimum of 48 consecutive hours before precautions can be discontinued.
Key Implementation Points
The 2018 IDSA/SHEA guidelines provide clear guidance on this timing:
- The 48-hour rule is based on resolution of diarrhea, not a specific count of formed stools 1
- The clock starts when the patient stops having diarrheal stools and begins having formed stools
- This is a weak recommendation with low quality evidence, but represents the current standard of care 1
Extended Precautions in High-Risk Settings
In facilities with persistently high CDI rates despite standard infection control measures, consider prolonging contact precautions until hospital discharge 1. This more aggressive approach should be implemented when:
- CDI rates remain elevated despite implementing standard precautions
- There is evidence of ongoing transmission within the facility
- Outbreak conditions exist
Critical Caveats
- Do not perform routine test of cure - stool testing should only be done if diarrheal symptoms persist or worsen, not to determine when to discontinue precautions 2
- Patients can remain colonized with C. difficile spores even after clinical resolution, which is why the 48-hour waiting period exists
- The precautions include both gloves and gowns, which must be used throughout the entire isolation period 1
The practical answer: No specific number of formed stools is required - rather, 48 hours must pass without any diarrheal stools before discontinuing precautions.