From the Guidelines
Patients with Clostridioides difficile (C. diff) infection should be isolated in a private room with a dedicated toilet to prevent transmission, as recommended by the Infectious Diseases Society of America (IDSA) and the Society for Healthcare Epidemiology of America (SHEA) 1.
Key Considerations for Isolation
- Private room isolation is essential to decrease transmission to other patients, especially for those with stool incontinence 1.
- If private rooms are limited, patients with C. diff infection should be prioritized for placement in these rooms 1.
- Cohorting patients with the same organism, in this case, C. diff, is recommended if private rooms are not available, to prevent the spread of other multidrug-resistant organisms 1.
- Healthcare workers should wear gloves and gowns when entering the patient's room and remove them before exiting, as well as practice hand hygiene with soap and water, which is more effective against C. diff spores than alcohol-based hand sanitizers 1.
Environmental Cleaning and Disinfection
- Environmental cleaning requires sporicidal agents like bleach solutions or other EPA-approved disinfectants specifically effective against C. diff spores 1.
- Daily to twice daily disinfection of high-touch surfaces and terminal cleaning of patient rooms with chlorine-based products can significantly reduce CDI rates 1.
- Newer alternatives for environmental decontamination, such as hydrogen peroxide vapor (HPV) and UV decontamination, have shown promise in reducing CDI rates 1.
Duration of Isolation
- Isolation should continue for at least 48 hours after diarrhea resolves, though some facilities may extend this period based on their specific protocols and the patient's condition 1.
- The decision to extend isolation should be made on a case-by-case basis, considering the risk of transmission and the patient's clinical status.
From the Research
C diff isolation
- C diff isolation is a critical aspect of managing Clostridium difficile infection (CDI) in healthcare facilities and the community 2.
- The recurrence rate of CDI remains high, up to 20%, and novel treatments and approaches have been developed to achieve higher sustained clinical cure in CDI 2.
- Fecal microbiota transplantation (FMT) has been shown to be effective in treating recurrent CDI, with higher success rates than vancomycin, fidaxomicin, or placebo 3, 4.
- FMT has traditionally been considered safe, with the most common adverse reactions being abdominal discomfort and diarrhea, and rare serious adverse events 4.
- Standardized microbiome-based therapies, such as SER-109 and RBX2660, have also demonstrated high efficacy rates in treating recurrent CDI and are now US Food and Drug Administration approved 4.
Treatment Options
- Vancomycin is often used as a first-line treatment for CDI, but fidaxomicin is a good alternative, especially in patients at risk of relapse 2.
- FMT is recommended for treatment of recurrent CDI, and can be used in combination with vancomycin for severe-complicated CDI 3, 5.
- Fidaxomicin has been shown to be effective in treating CDI in patients with inflammatory bowel disease, with a response rate of 60.6% 6.
- Fecal microbiota transplantation can be an effective therapy for patients who do not respond to fidaxomicin 6.
Prevention and Management
- Preventing CDI during antibiotic therapy is crucial, and new medications that protect the gut microbiota are being developed and tested 2.
- Antibiotic neutralization strategies, vaccines, passive monoclonal antibodies, and drug repurposing are other therapeutic strategies being explored to treat CDI 4.
- A sequential FMT and antibiotic protocol has been shown to be effective in treating severe and severe/complicated CDI, with a high success rate of 93% 5.