From the Guidelines
Contact isolation for a patient with C. difficile colitis being treated with vancomycin can be discontinued after 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) in their 2017 update 1. This guideline is based on the principle that the risk of transmission of C. difficile significantly decreases once the patient's diarrhea has resolved. It is crucial to ensure that the patient has formed or normal stools before considering discontinuation of contact isolation.
- The patient's full course of vancomycin treatment, typically lasting 10-14 days, can continue even after isolation is discontinued, provided the diarrhea criterion is met.
- Healthcare facilities may have varying policies, potentially requiring completion of antibiotic treatment before discontinuing isolation, especially in high-risk settings.
- Emphasis should be placed on good hand hygiene with soap and water, rather than alcohol-based sanitizers, which are ineffective against C. difficile spores, even after isolation is discontinued, as patients may continue to shed spores for weeks following clinical recovery.
- The IDSA and SHEA guidelines also suggest prolonging contact precautions until discharge if C. difficile infection rates remain high despite standard infection control measures 1, highlighting the importance of considering the broader epidemiological context within the healthcare facility.
From the Research
Discontinuation of Contact Isolation for C diff Colitis Patients
To determine when contact isolation can be discontinued for a patient with C difficile (C diff) colitis being treated with vancomycin, several factors must be considered:
- The patient's response to vancomycin treatment
- The presence of C difficile in stool samples
- The risk of relapse or transmission to others
Response to Vancomycin Treatment
Studies have shown that vancomycin is effective in treating C diff colitis, with most patients showing significant improvement within 7-10 days of treatment 2, 3. However, the duration of treatment and the dosage regimen may vary depending on the severity of the disease and the patient's response to treatment 4, 5.
Presence of C difficile in Stool Samples
C difficile can persist in stool samples even after completion of vancomycin treatment, and this persistence may be associated with an increased risk of relapse 6. Therefore, stool cultures and cytotoxin assays may be necessary to determine when contact isolation can be safely discontinued.
Discontinuation of Contact Isolation
Based on the available evidence, contact isolation can be discontinued when:
- The patient has completed a full course of vancomycin treatment (usually 10-14 days)
- Stool cultures and cytotoxin assays are negative for C difficile
- The patient has shown significant clinical improvement, with no diarrhea or abdominal pain for at least 48 hours
- The risk of transmission to others has been minimized, and the patient is no longer considered infectious 4, 6, 5, 2, 3
Key Considerations
- Vancomycin treatment should be continued for at least 10 days to ensure eradication of C difficile 5
- Stool cultures and cytotoxin assays should be performed during and after treatment to monitor for persistence of C difficile 6
- Patients who have completed treatment and show no signs of infection can be considered for discontinuation of contact isolation 4, 2, 3