UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.e

Abstract

Background: An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.

Methods: The UVM was applied to the toilets of patients who were on isolation precautions due to Clostridium difficile-associated diarrhea (CDAD) as well as for patients who were not on isolation precautions. Cleaning was visually scored using a numeric system where 0, 1, 2, and 3 represented; no, light, moderate or heavy residual UVM. Rodac plates containing CDMN selective agar were used to test for the presence of C. difficile on the surfaces of patient's toilets.

Results: Despite twice daily cleaning for the toilets of patients who were on CDAD isolation precautions, the average cleaning score was 1.23 whereas the average cleaning score for toilets of patients not on isolation precautions was 0.9. Even with optimal cleaning (UVM score of 0) C. difficile was detected from 33% of the samples taken from toilets of patients with CDAD (4% detection in toilet samples from patients who had diarrhea not due to CDAD).

Conclusion: Our data demonstrated the value of UVM for monitoring the compliance of housekeeping staff with the facility's toilet cleaning protocol. In addition to providing good physical cleaning action, agents with some sporicidal activity against C. difficile may be needed to effectively reduce the environmental reservoir.

Figure 1

UV visible marker for verification of toilet cleaning. Toilet seat lids visualized with regular light (A), and with UV light (B, C, D). The UV marker is scored at 3; shows heavy residual UVM (B), 2; shows moderate residual UVM (C), 1 shows light residual UVM (D), and 0: shows no residual UVM (not shown).

Figure 2

Routine ward monitoring using the UVM. Ward 1 (14 rooms) is shown as the solid bar, ward 2 (11 rooms) is shown as the cross-hatched bar, and ward 3 (11 rooms) is shown as the white bar. The toilet in each room was monitored every day prospectively for a week (Monday to Friday). There were 66, 33 and 44 test samples taken from wards 1, 2 and 3, respectively. For ward 2 there was a STAT holiday and samples were not taken on that day so there were 33 samples instead of 44 samples in total.