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Review
. 2023 Sep 7;12(1):94.
doi: 10.1186/s13756-023-01295-z.

Environmental approaches to controlling Clostridioides difficile infection in healthcare settings

Philip C Carling  1 , Michael F Parry  2 , Russell Olmstead  3
Affiliations
Review

Environmental approaches to controlling Clostridioides difficile infection in healthcare settings

Philip C Carling et al. Antimicrob Resist Infect Control. .

Abstract

As today's most prevalent and costly healthcare-associated infection, hospital-onset Clostridioides difficile infection (HO-CDI) represents a major threat to patient safety world-wide. This review will discuss how new insights into the epidemiology of CDI have quantified the prevalence of C. difficile (CD) spore contamination of the patient-zone as well as the role of asymptomatically colonized patients who unavoidable contaminate their near and distant environments with resilient spores. Clarification of the epidemiology of CD in parallel with the development of a new generation of sporicidal agents which can be used on a daily basis without damaging surfaces, equipment, or the environment, led to the research discussed in this review. These advances underscore the potential for significantly mitigating HO-CDI when combined with ongoing programs for optimizing the thoroughness of cleaning as well as disinfection. The consequence of this paradigm-shift in environmental hygiene practice, particularly when combined with advances in hand hygiene practice, has the potential for significantly improving patient safety in hospitals globally by mitigating the acquisition of CD spores and, quite plausibly, other environmentally transmitted healthcare-associated pathogens.

Keywords: Clostridioides difficile; Disinfection cleaning; Healthcare-associated infections; Hospital onset Clostridioides difficile infection prevention; Optimized cleaning performance; Sporicidal disinfectant.

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Conflict of interest statement

PC, Licensed patents to Ecolab, Inc., StPaul, MN, USA; MP and RO, no competing interests.

Figures

Fig. 1
Fig. 1
The elements of Horizontal Healthcare Hygienic Practices. The blue arrows represent the interdependence between the elements
Fig. 2
Fig. 2
The thoroughness of disinfection cleaning as objectively documented by the standardized florescent marker monitoring program
Fig. 3
Fig. 3
The CDC core elements of environmental cleaning and disinfection in hospitals
Fig. 4
Fig. 4
The impact of optimizing environmental hygiene to decrease Clostridioides difficile transmission in a single hospital over two and one half years
Fig. 5
Fig. 5
Toroughness of Cleaning in 8 Intervention Hospitals
Fig. 6
Fig. 6
The trend in HO-CDI SIR pre and post-intervention
Fig. 7
Fig. 7
Evaluation of potential confounding influences. 1. Q3 pre-intervention year “Enhanced contact precautions for CD positive patients was implemented”. During the first 6 to 9 months of the pre-intervention period these sites implemented nursing education to clarify the importance of early stool specimen collection in patients with diarrhea
Fig. 8
Fig. 8
Evaluation of the modeled cost (cost-avoidance) associated with interventions to mitigate HO-CDI
Fig. 9
Fig. 9
Comparison of the modeled and observed HO-CDI over 6 years
Fig. 10
Fig. 10
Studies which have clarified the potential for optimized patient-zone disinfection cleaning to mitigate the transmission of healthcare -associated organisms from environmental surfaces
See this image and copyright information in PMC

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