Erik R. Dubberke, MD, MSPH, of the Division of Infectious Diseases in the Department of Medicine at Washington University School of Medicine in St. Louis, describes in Infection Control & Hospital Epidemiology the components of a successful program to control and prevent Clostridium difficile infection (CDI).
While Dubberke acknowledges that "studies are needed to define the optimal prevention practices and to investigate novel prevention methods," he points to the wearing of gloves when caring for a patient with CDI as the single recommended practice that is graded "A-I" and thus shown to have good evidence to back it up.
Dubberke says that a study (Johnson S, Gerding DN, Olson MM, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med 1990;88(2):137140) conducted prior to the advent of universal and standard precautions randomized four wards with similar baseline rates of CDI to provide standard of care or to conduct an educational intervention. The intervention consisted of an educational campaign instructing nurses to wear gloves when handling body fluids and stool. Boxes of gloves were placed at each patients bedside on the intervention wards. There was a statistically significant decrease in CDI incidence on the intervention wards, from 7.7 to 1.5 cases per 1,000 patient-days, and no significant change in CDI incidence on the control wards (from 5.7 to 4.2 cases per 1,000 patient-days). Point prevalence assessments of asymptomatic C. difficile carriage were conducted before and after the intervention, and there was a statistically significant decrease in the proportion of patients colonized with C. difficile on the intervention wards (from 27 percent to 9 percent of patients; ), but no significant difference on the control wards (from 17 percent to 10 percent of patients).
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Reference: Dubberke ER. Prevention of Healthcare-Associated Clostridium difficile Infection: What Works? Infect Control Hosp Epidemiol 2010;31:S38S41.