From the Guidelines
Patients with Clostridioides difficile (C. diff) colitis can be removed from isolation when they have been symptom-free for at least 48 hours, specifically when they no longer have diarrhea. This means the patient should have formed or normal stools for a minimum of two days before discontinuing isolation precautions. There is no need to perform repeat testing for C. diff as a "test of cure" since patients may continue to shed spores even after successful treatment and resolution of symptoms.
Key Considerations
- When caring for these patients, healthcare workers should use contact precautions including gloves and gowns, and practice thorough hand hygiene with soap and water rather than alcohol-based hand sanitizers, as alcohol does not effectively kill C. diff spores.
- The room should be cleaned with sporicidal agents such as bleach-based products.
- This approach is necessary because C. diff forms highly resistant spores that can survive in the environment for months and are easily transmitted through the fecal-oral route.
- Even after isolation is discontinued, continued attention to hand hygiene and environmental cleaning remains important to prevent transmission, as supported by guidelines from the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) 1.
Additional Guidance
- The decision to remove a patient from isolation should be based on clinical judgment and consideration of the patient's individual circumstances, including the severity of their illness and their response to treatment.
- It is also important to note that some patients may require prolonged isolation precautions, such as those with severe or fulminant CDI, or those who are immunocompromised, as suggested by studies on the management of CDI in special populations 1.
From the Research
Determining Safe Removal from Isolation for C. diff Colitis Patients
To determine when it is safe to remove a patient with Clostridioides difficile (C. diff) colitis from isolation, several factors must be considered, including the resolution of symptoms and the risk of transmission to others.
- Resolution of Symptoms: The patient should no longer be experiencing symptoms of C. diff infection, such as diarrhea, abdominal pain, and fever 2.
- Treatment Response: The patient should have responded to treatment, whether it be with antibiotics such as vancomycin or fidaxomicin, or with fecal microbiota transplantation (FMT) 3, 4, 2, 5.
- Risk of Transmission: The risk of transmission to others should be minimized, which can be achieved by ensuring the patient is no longer shedding the bacteria in their stool 5.
Considerations for Removal from Isolation
The decision to remove a patient from isolation should be made on a case-by-case basis, taking into account the individual patient's circumstances and the risk of transmission to others.
- Test of Cure: Some studies suggest that a test of cure, such as a stool test for C. diff, may be necessary to confirm that the patient is no longer infected before removing them from isolation 2.
- Infection Control Measures: Infection control measures, such as proper hand hygiene and use of personal protective equipment, should continue to be followed even after the patient is removed from isolation to minimize the risk of transmission 5.
Evidence-Based Guidelines
There is no single study that provides a clear answer to when it is safe to remove a patient with C. diff colitis from isolation. However, based on the available evidence, it is likely that a patient can be safely removed from isolation when they have responded to treatment, are no longer experiencing symptoms, and are no longer shedding the bacteria in their stool 3, 4, 2, 5.