From the Guidelines
The best approach to prevent Clostridioides difficile (C. diff) transmission in this scenario is to change to doors with leg pulling mechanisms (option 2). This directly addresses the main transmission route in the described case, where both patients touched the same door handle despite hand washing. C. diff forms spores that are resistant to alcohol-based hand sanitizers and can persist on environmental surfaces for months. Even though both patients washed their hands with soap and water (which is appropriate for C. diff), the contaminated door handle served as a fomite for transmission. Installing doors with leg-operated mechanisms eliminates the need to touch handles with hands, breaking this transmission chain. While cleaning protocols and staff education are important, they don't directly address the specific mechanical issue of door handle contamination. Telemedicine for C. diff patients is excessive and impractical for ongoing patient care. The leg-pull door mechanism represents a sustainable engineering control that reduces infection risk without requiring constant vigilance or behavioral changes. According to the 2019 update of the WSES guidelines for management of Clostridioides difficile infection in surgical patients 1, hand hygiene with soap and water is the cornerstone of the prevention of C. difficile infection, but it does not address the issue of fomites like door handles.
Some key points to consider:
- C. diff spores can survive for months on environmental surfaces 2
- Hand hygiene with soap and water is essential, but it may not remove all spores from hands 1, 3
- Environmental cleaning and disinfection are crucial in preventing C. diff transmission, especially in outbreak settings 1, 2
- The use of sporicidal agents, such as sodium hypochlorite solutions, is recommended for environmental cleaning and disinfection 1
- Education of healthcare workers on C. diff prevention is also important, but it does not directly address the issue of door handle contamination 1
Overall, changing to doors with leg pulling mechanisms is the most effective way to prevent C. diff transmission in this scenario, as it directly addresses the main transmission route and reduces the risk of infection.
From the Research
Prevention of C. difficile Infection
To prevent the spread of C. difficile infection, several measures can be taken:
- Education of staff about C. difficile prevention is crucial, as it can help reduce the risk of transmission 4, 5
- Hand hygiene with soap and water is essential, as C. difficile spores cannot be destroyed by standard alcohol-based hand disinfection 4, 6, 7
- Environmental cleaning and disinfection, particularly with sporicidal cleaning agents, can help reduce the spread of C. difficile 4, 6, 7
- Contact precautions, such as isolation of patients with C. difficile infection, can also help prevent transmission 4, 6, 7
- Antibiotic stewardship is important to minimize the selective pressure for C. difficile 4, 6, 7
Specific Measures to Prevent Transmission
In the scenario described, where Pt A has C. difficile and passes watery stool, and Pt B also gets C. difficile after 6 weeks, several measures can be taken to prevent transmission:
- Cleaning the washroom twice a day may not be sufficient to prevent transmission, as C. difficile spores can survive for months in the environment 4
- Changing to doors with leg-pulling mechanisms may not be effective in preventing transmission, as the spores can still be spread through hand contact 4
- Teaching the staff about C. difficile prevention is essential, as it can help reduce the risk of transmission 4, 5
- Telling C. difficile patients to not come to the clinic and instead using video calls may not be a practical or effective solution, as it may not be feasible for all patients and may not prevent transmission in all cases 4, 6, 7
Role of Patient Hand Hygiene
Patient hand hygiene can play an important role in preventing C. difficile infection, particularly in hospitalized patients 8