How long should a patient with Clostridioides difficile (C. diff) be isolated?

Duration of Isolation for Patients with Clostridioides difficile Infection

Patients with Clostridioides difficile infection should be isolated with contact precautions for at least 48 hours after diarrhea has resolved. 1

Isolation Requirements

Standard Isolation Protocol

• Implement contact precautions immediately upon suspicion of CDI
• Place patient in a private room with a dedicated toilet 1
• If private rooms are limited, prioritize patients with stool incontinence 1
• Healthcare personnel must use gloves and gowns when entering the room and while caring for CDI patients 1

Duration of Isolation

The duration of isolation depends on institutional CDI rates:

• Standard recommendation: Continue contact precautions for at least 48 hours after diarrhea has resolved 1
• For facilities with high CDI rates: Prolong contact precautions until patient discharge despite implementation of standard infection control measures 1

Rationale for Isolation Duration

The 48-hour recommendation is based on several important findings:

1. Persistent contamination: Even after diarrhea resolves, skin and environmental contamination remains high (60% and 37% respectively) 1
2. Continued shedding: Patients may continue to shed C. difficile spores for up to 6 weeks after successful treatment 1
3. Transmission risk: C. difficile spores can survive for prolonged periods on surfaces and are resistant to many disinfectants

Preemptive Isolation

• Place patients with suspected CDI on preemptive contact precautions while awaiting test results if results cannot be obtained on the same day 1
• This is critical as the frequency of C. difficile acquisition on gloved hands of healthcare personnel after skin contact with infected patients is approximately 69% 1

Hand Hygiene Considerations

• In routine settings: Either soap and water or alcohol-based hand hygiene products can be used before and after patient contact 1
• During outbreaks or in high-prevalence settings: Perform hand hygiene with soap and water preferentially instead of alcohol-based products due to increased efficacy of spore removal 1

Environmental Cleaning

• Daily cleaning with a sporicidal agent should be implemented during outbreaks or in high-prevalence settings 1
• Consider sporicidal cleaning if there are repeated cases of CDI in the same room 1

Special Considerations

Patient Cohorting

• If private rooms are unavailable, cohort patients with the same organism(s) 1
• Do not cohort CDI patients with patients who have other multidrug-resistant organisms 1

Testing Considerations

• Do not perform repeat testing within 7 days during the same episode of diarrhea 1
• Do not perform "test of cure" as patients may asymptomatically shed C. difficile for weeks 1

Common Pitfalls to Avoid

1. Premature discontinuation of isolation: Ending precautions immediately after diarrhea resolves increases transmission risk
2. Unnecessary repeat testing: Testing within 7 days of a positive result or performing "test of cure" is not recommended 1
3. Improper hand hygiene: Using only alcohol-based sanitizers during outbreaks (soap and water is preferred)
4. Inadequate environmental cleaning: Failure to use sporicidal agents in rooms of CDI patients

By following these evidence-based isolation practices, healthcare facilities can effectively reduce the transmission of C. difficile and prevent healthcare-associated infections.