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Up-and-Coming Prevention Methods for Clostridium difficile

MAR 06, 2017 | CONTAGION EDITORIAL STAFF

Can You Discuss Some of the More Recent Decontamination Technologies Designed for Use in Healthcare Facilities? 

“There [are] two relatively recent technologies that have come on the market that are important for infection control. [They] are more widely applied in hospitals and I think they will have a space in long-term care as well. The problem, [is] that they’re very expensive, but they do seem to have some effectiveness.  
 
One of these [technologies] is hydrogen peroxide vapor [and] people [often] use this to disinfect or decontaminate large spaces. Some of the down-sides of using hydrogen peroxide vapor [is that] we have to close off the ventilation system, close off the doors, and create a seal within the room. I haven’t looked at it in a couple of years but this is what I [am] aware of.  
 
The UV devices seem to be more user-friendly. These are devices where all you have to do is shut the door of the room. So the device goes in, the door gets shut, the device is then programmed to disseminate UV light throughout the room, it bounces around so it can get to those difficult to reach surfaces, like underneath things and around things, and it works to kill the spores. It can take up to about 45 minutes to an hour and it may have to be done in two sessions, so one time in the room and one time in a bathroom, for example. If we’re looking at two hours to do a cleaning of a room, or two hours to get the spore burden down, it’s completely worth doing that, and that can serve as the terminal clean to then allow the resident and perhaps their roommate to be back in the room. It’s also as I said before, very, very expensive to invest in these machines.” 
 

Can You Comment on the Study,“Effect of Detecting and Isolating Clostridium difficile Carriers at Hospital Admission on the Incidence of C difficile Infections: A Quasi-Experimental Controlled Study.”

“These efforts to screen asymptomatic [Clostridium difficile] carriers and their admission to the hospital are an extension of what has been done already with methicillin-resistant Staphylococcus aureus, or MRSA, and it’s a fantastic idea; I am pleased to see that [clinicians] were able to show a decrease in the expected rate of C. diff cases. They estimated based on their study outcomes that they prevented 63 of 101 healthcare associated C. difficile cases, which is fantastic and commendable. To achieve this, the numbers estimate that they had to screen about 120 people on admission to the hospital and isolate 6 asymptomatic carriers to prevent those cases of C. difficile. This seems to be a very rational approach and I like it.

I expect that based on what it costs to screen people, including the microbiology laboratory time and doing the actual cultures versus having a case of C. diff in the hospital, I expect that it’s very cost effective. Patients may not like it; they don’t always like being on contact precautions for MRSA either but in the public health setting this seems to make sense and it seems to be where we have to go at this point given the burden of drug-resistant organisms.

It [also] seems to make good sense to isolate preemptively rather than wait until after we know that someone is sick or to isolate preemptively rather than wait until after we know someone is sick or to isolate preemptively so that someone who is a carrier doesn’t lead to healthcare workers spreading spores to other patients and making them sick as well.

I think some of the barriers to implementing active surveillance and putting asymptomatic carriers in isolation pertain to cost and the effort that’s required on the part of the nursing staff, because they are the ones that will have to do this. There may be also some reluctance on the part of the patients, too, because this is different from getting your nose swabbed; this is a different part of the body that has to get swabbed, and that’s not always something that we are very comfortable with. I don’t think I would be upon admission to the hospital. A second potential barrier may be that this is [just] one study and [though] I think that it is worthwhile pursuing, there may be a call for more evidence before we can start making this a widespread investment into healthcare infection control and prevention.”