From the Guidelines
Yes, contact precautions are generally recommended for patients who are C. diff NAAT positive but toxin negative. While the toxin negative result suggests the organism may not be actively producing toxins, the NAAT (Nucleic Acid Amplification Test) positivity indicates the presence of C. difficile bacteria capable of producing toxins. The clinical significance of this discordant result (NAAT+/toxin-) remains controversial, but healthcare facilities typically err on the side of caution to prevent potential transmission.
Key Considerations
- Contact precautions include using gloves and gowns when entering the patient's room, dedicated equipment, and enhanced environmental cleaning with sporicidal agents.
- These measures are important because C. difficile forms spores that can persist in the environment and are resistant to many standard cleaning agents.
- The precautions should be maintained until the patient has completed treatment or until diarrhea has resolved for at least 48 hours.
- This approach helps protect other vulnerable patients from potential C. difficile transmission, as even non-toxigenic strains could potentially acquire toxin-producing capabilities through horizontal gene transfer.
Evidence Support
- A study by Sartelli et al. 1 recommends that C. difficile carriers should be placed in contact (enteric) precautions, and this is supported by the finding that asymptomatic carriers can contribute to the transmission of C. difficile in the hospital setting.
- Another study by McDonald et al. 2, 3, 4, 5 provides guidance on the management of C. difficile infection, including the use of contact precautions, but the most recent and highest quality study is from Sartelli et al. 1.
Clinical Implications
- The use of contact precautions for patients who are C. diff NAAT positive but toxin negative is a precautionary measure to prevent the potential transmission of C. difficile.
- Healthcare facilities should prioritize the prevention of C. difficile transmission, as it can have significant morbidity, mortality, and quality of life implications for patients.
From the Research
Contact Precautions for C. difficile NAAT Positive but Toxin Negative
- The provided studies do not directly address the need for contact precautions for individuals who are C. difficile NAAT positive but toxin negative 6, 7, 8, 9, 10.
- However, it is known that C. difficile can be transmitted through contact with contaminated surfaces or healthcare workers' hands, and that individuals who are colonized with C. difficile can still transmit the bacteria even if they are not showing symptoms 7, 8.
- The studies focus on treatment options for C. difficile infection, including vancomycin, fidaxomicin, and fecal microbiota transplantation, as well as emerging therapies such as monoclonal antibodies and microbiome-based therapies 6, 7, 8, 9, 10.
- There is no clear guidance on contact precautions for individuals who are C. difficile NAAT positive but toxin negative, and further research is needed to determine the best approach for preventing transmission in this scenario.