Can a patient catch C difficile if the previous hospital room occupant had it?
Clostridioides difficile is an ongoing issue with health care-acquired infections in every hospital worldwide. With terminal cleans, the hospital rooms the patients with C difficile were in should be safe, right? Several studies, however, have shown that the next patient—or even patients months or a year later—is not safe.
Infection Control Today® (ICT®) spoke to Geetika Sood, MD, ScM, assistant professor of medicine and hospital epidemiologist at Johns Hopkins Bayview Medical Center and lead author of “Clostridioides difficile infection (CDI) in a previous room occupant predicts CDI in subsequent room occupants across different hospital settings” published in American Journal of Infection Control.
ICT®: Please give a summary of the key findings of your study and why they're important.
Geetika Sood, MD, ScM: Thank you for talking about our study. We looked to see if patients who had been in a room that was previously occupied by somebody who had C difficile, if they had a higher risk of infection either 90 days after they had been exposed to that contaminated room, or after 365 days after they had been exposed to that room. And what was surprising was that there was a higher risk of infection in 90 days, which was 27% higher odds, but it was it continued for the entire year. There were a continued 40% increased odds of infection even 1 year after being exposed to a contaminated room. That was interesting because it was multicenter, so there were many hospitals that were involved with slightly different cleaning practices. But the findings were across the board and because of the prolonged duration that this exposure had in terms of impact on C difficile rates.
ICT®: Please give some ideas of what the spaces are, besides the obvious high-touch areas, that are often overlooked as problem areas for C difficile. What hidden areas are there?
GS: That's an important and good point because we, at this point, know how to clean high-touch areas, and many hospitals are monitoring the cleaning of high-touch areas. The mechanism of how this environmental contamination impacts occupants of the room must be in some of these sequestered sites that we're not thinking about. You bring up a key point in looking for hidden areas that we're not always thinking about when it comes to cleaning. Beds certainly can be an area like that [and] countertops. Many older hospital rooms have many nooks and crannies that may not be intuitively obvious. We've also seen in our hospital that there have been clusters of infections that are related to things that you may not think about, like overflowing trash bins from [an individual who] has C difficile. If you are using that trash can, and are not careful, you can contaminate yourself and take that to another room as well. That wasn't looked at in this study but it certainly shows us that there are clearly environmental sources that we aren't paying enough attention to.
ICT®: What is the practical application for the key findings of your study for infection preventionists for environmental service personnel from your study?
GS: This [study] adds to the knowledge and literature that we've had knowing that environmental contamination is such an important mechanism for C difficile infection. You must be colonized with this organism first, and then other precipitating factors can cause you to develop an infection. We didn't know that the environment was an important source. That's been there have been varied findings in terms of how important of a source it is. This study emphasizes that [the hospital room that contained a patient with C difficile] continues to be an important environmental source and that it extends for a much longer period than we had thought about previously. Those findings practically mean that we need to focus more on environmental cleaning, even than we do now. And we're certainly focusing on it more now than we did a few years ago.
ICT®: What do you want to tell infection preventionist, environmental services (EVS) personnel, and patients about C difficile?
GS: First, I think most people know that it is a significant disease that causes a lot of morbidities and in rare cases, a lot of mortality. It is something that we want to take seriously and be careful about. It tends to be seen more in the environment. The emphasis on the environment is very important. I would want to let infection preventionists and especially our EVS partners know you are so incredibly important in us being able to prevent infections and save lives. The importance of being able to clean the environment, the importance of being vigilant about areas that you may not be thinking about, usually the non-high touch surface areas, all those things are going to help us collectively be better about preventing this significant disease.
ICT®: Is there anything else you would like to add?
GS: I would add on a more positive note that, in the future, there are even more environmental interventions that are coming along that are going to be helpful to prevent transmission, and very encouragingly, there are many therapeutic interventions for our patients that are going to be helpful in terms of preventing recurrence preventing having C difficile as a chronic disease, and for curing patients who are unfortunate enough to have gotten C difficile. It's unfortunate that there is such a likelihood of developing disease, especially in hospital settings. But attention to that will help us prevent transmission. Along with that, the therapeutic interventions that we have are developing rapidly, and will also help us make sure we take care of our patients the best that we can.
Thank you to everybody out there who's working every day to protect our patients and our staff.
The interview has been edited for length and clarity.