Abstract
The airborne dissemination of Clostridium difficile (C. difficile) endospores (spores) in healthcare environments is documented in multiple studies. Once airborne, spores have the potential for transport on air currents to other areas. This study compared the methods in the collection of C. difficile spore aerosol. This study determined the relative efficiency of commonly used bioaerosol air sampling methods when characterizing airborne C. difficile spore concentrations. Air samplers evaluated in this study were the AirTrace slit-to-agar impactor, AGI-30 impinger, SKC BioSampler impinger, and a 47-mm mixed cellulose ester (MCE) filter cassette. Non-toxigenic C. difficile spores were nebulized into an enclosure contained in a biological safety cabinet. Side-by-side air samples were drawn from the enclosure. The slit-to-agar impactor, successfully used in previous studies to collect airborne spores, served as the reference method. Relative efficiency for the 47-mm MCE filter cartridge was higher than the slit-to-agar impactor (mean 136.6%, 95% CI 124.7–148.5%). Efficiencies of the impingers were similar and were low (mean 4.13%, 95% CI 2.27–5.99%). Impingers failed to maintain culturability of C. difficile spores during sampling. This study is the first to compare the efficiencies of commonly used bioaerosol sampling methods to collect airborne C. difficile spores. Filter air sampling provided the greatest collection of airborne spores. Slit-to-agar air sampling may underestimate the number of airborne spores present. Impinger air sampling could significantly underestimate the actual number of airborne C. difficile spores present or fail to detect airborne spores.
Highlights
1.1 BackgroundHealthcare-acquired Clostridium difficile infection (CDI) is a significant burden to US healthcare facilities and their patients, with an estimated 453,000 incident CDI and 29,000 deaths in 2011 (Lessa et al 2015)
Impinger bioaerosol sampling as conducted in this work was not effective for characterizing airborne C. difficile spore concentrations
The two impingers had equivalent performance, which was extremely poor compared to both the slit-to-agar impactor and mixed cellulose ester (MCE) filters
Summary
Healthcare-acquired Clostridium difficile infection (CDI) is a significant burden to US healthcare facilities and their patients, with an estimated 453,000 incident CDI and 29,000 deaths in 2011 (Lessa et al 2015). Of these nearly half million cases, an estimated 293,300 were healthcare-associated with 107,600 hospital onset, 104,400 nursing home onset, and 81,300 postoutpatient care onset. CDI patients experience multiple episodes of watery diarrhea each day, and both C. difficile bacterial endospores (spores) and vegetative cells are shed in stool. The spores are infectious, and CDI transmission is believed to be primarily via hand contact with the patient and contaminated environmental surfaces during patient care (McDonald et al 2018)
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