What are the fomite transmission and cleaning recommendations for Clostridioides difficile (C. diff)?

From the Guidelines

To prevent the spread of Clostridioides difficile (C. diff) via fomites, thorough cleaning with bleach-based disinfectants is essential, as recommended by the most recent guidelines 1. The most effective approach to cleaning and disinfection involves using a 1:10 solution of household bleach (mixing 1 part bleach with 9 parts water) to clean all potentially contaminated surfaces, allowing the solution to remain on surfaces for at least 10 minutes to effectively kill C. diff spores 1. Key areas to focus on include high-touch areas like doorknobs, light switches, bathroom fixtures, and any medical equipment. For home settings where a C. diff patient is recovering, daily cleaning of bathrooms and frequently touched surfaces is recommended, with hydrogen peroxide-based cleaners (3%) also being effective alternatives to bleach 1. It is crucial to always wear gloves when cleaning and to wash hands thoroughly with soap and water afterward, as alcohol-based hand sanitizers are not effective against C. diff spores 1. Disposable cleaning materials are preferable to prevent cross-contamination. These stringent cleaning protocols are necessary because C. diff forms hardy spores that can survive on surfaces for months and resist many standard cleaning agents, making thorough disinfection crucial to breaking the transmission cycle. Some of the key recommendations from recent guidelines include:

• Using personal protective equipment (gloves and gowns/disposable aprons) to decrease transmission of C. difficile 1
• Implementing daily environmental sporicidal disinfection and terminal disinfection of rooms of patients with CDI to decrease the transmission of CDI 1
• Performing surveillance of CDI in combination with timely feedback of infection rates on both the hospital and ward level 1
• Restricting protocols of antibiotic agents/classes and implementing protocols to reduce the duration of antibiotic therapy, as these are effective in reducing CDI rates 1

From the Research

C. diff Fomite and Cleaning Advice

• C. diff spores can survive on surfaces and fabrics, making them a potential source of transmission 2
• Effective cleaning and disinfection of surfaces and medical equipment is crucial in controlling C. difficile transmission 3
• Not all surface disinfectants with a sporicidal claim are effective against C. difficile spores, highlighting the need for careful selection of disinfectants 4
• The use of sporicidal disinfectants in all postdischarge hospital rooms may not significantly reduce environmental contamination with C. difficile spores 5
• Alternative strategies, such as using disinfectants with proven efficacy against C. difficile spores, may be needed to break the chain of transmission in clinical environments 2

Disinfectant Efficacy

• Peracetic acid-based disinfectants (products A, C, and D) were effective against C. difficile spores in suspension and on surfaces 4
• Hydrogen peroxide-based disinfectant (product B) was not effective against C. difficile spores in suspension and on surfaces 4
• Glutaraldehyde-based disinfectant (product E) demonstrated some efficacy against C. difficile spores, but required a longer contact time 4
• Sodium hypochlorite disinfectant was not effective against C. difficile spores, even at high concentrations 2

Testing Standards

• Current testing standards for sporicides may not reflect real-world applications, highlighting the need for more realistic and effective testing methods 6
• The use of contaminated carriers rather than spore suspensions may provide a more accurate assessment of disinfectant efficacy 6