From the Guidelines
Contact precautions for Clostridioides difficile (C. diff) infection should be implemented immediately for patients suspected of having CDI, and continued for at least 48 hours after diarrhea has ceased.
Key Components of Contact Precautions
- Hand hygiene: Hand hygiene with soap and water is the cornerstone of prevention of C. difficile infection, and should be performed before and after contact with a patient with CDI, and after removing gloves 1.
- Personal protective equipment (PPE): Use of PPE, including gloves and gowns/disposable aprons, should be used to decrease transmission of C. difficile 1.
- Environmental cleaning: Daily environmental sporicidal disinfection and terminal disinfection of rooms of patients with CDI should be performed to decrease the transmission of CDI 1.
- Private room: Patients with CDI should be placed in a private room with en suite hand washing and toilet facilities, if possible 1.
Rationale for Contact Precautions
- C. difficile spores can survive for months in the environment, despite regular use of environmental cleaning agents 1.
- Skin and environmental contamination can remain high even after diarrhea has resolved 1.
- Continued contact precautions for at least 48 hours after diarrhea has ceased can help reduce the transmission of CDI 1.
Special Considerations
- In CDI outbreaks or hyperendemic settings, hand hygiene with soap and water should be performed preferentially instead of alcohol-based hand hygiene products 1.
- Prolonging contact precautions until discharge may be considered a special control measure if CDI rates remain high despite implementation of standard infection control measures against CDI 1.
From the Research
Contact Precautions for C. diff Infection
The following are contact precautions for Clostridioides difficile (C. diff) infection:
- Contact precautions are a crucial component of multimodal interventions to prevent C. diff infection, along with hand hygiene with soap and water, effective environmental cleaning, and antimicrobial stewardship 2, 3, 4
- Visitor contact precautions (VCPs) are commonly used to reduce the transmission of C. diff, but their effectiveness is uncertain 5
- Studies have shown that VCPs may not be associated with a significant reduction in hospital-onset C. diff infection (HO-CDI) rates 5, 6
- Other interventions, such as daily cleaning with sporicidal disinfectant, C. diff screening at admission, and hand hygiene, may be more effective in reducing HO-CDI rates 6
- Healthcare worker contact precautions are considered one of the least effective interventions in reducing hospital-onset colonization and infection 6
Key Findings
- Contact precautions are an important part of C. diff prevention, but their effectiveness may be limited when used in isolation 2, 3, 4
- A multifaceted approach, including hand hygiene, environmental cleaning, and antimicrobial stewardship, is likely to be more effective in preventing C. diff infection 2, 3, 4
- The use of VCPs may not be the most effective strategy for reducing HO-CDI rates, and other interventions may be more beneficial 5, 6