Household hygiene advice for patients with Clostridium difficile: Summary of hospital practice in Ontario, Canada

Abstract

Background: While Clostridium difficile infection is a significant concern in healthcare settings, there is increasing evidence that transmission does not solely occur in hospitals and long-term care homes. Hospital patients are regularly discharged home following or during treatment, and it is likely that many excrete spores into their household environment, posing risks of reinfection to themselves and transmission of spores to others. Hence, recommendations on household hygiene might be important for control of C. difficile. The objective of this study was to investigate the information provided by Ontario hospitals to patients who have laboratory-confirmed symptomatic C. difficile infection with respect to household hygiene advice once they are discharged from hospital. Methods: This cross-sectional study was conducted between January and August 2018 and included an anonymous online survey, a website scan of Ontario hospitals, and a content analysis of information provided to patients on discharge. The survey was distributed to practicing infection control professionals in Ontario hospitals through the IPAC Canada listserv. One response per hospital corporation was accepted. Results: Responses were obtained from 46/145 (32%) Ontario hospital corporations. The majority (30/46; 65%) of respondents indicated they personally believed the household environment was important or very important in the transmission of C. difficile. Almost half (22/46; 48%) of respondents reported that their hospital had a policy to provide household hygiene advice to patients when discharged home. However, analysis of 31 hospital information sheets from the website scan identified that 27/31 (88%) contained a statement that suggested there is little risk of transmission in households, and only 2/31 (6.5%) provided the specific dilution of bleach that is known to be sporicidal. Conclusion: The household hygiene advice provided by Ontario hospitals downplayed the likelihood of transmission of C. difficile spores in household environments and described a level of hygiene that is likely inadequate to prevent transmission of C. difficile spores in the home. This may contribute to recurrent infection and colonization of household contacts.