Infection control and diarrhoeal pathogens

Abstract

Norovirus and <i>Clostridium difficile</i> infections are presenting new challenges to healthcare systems worldwide. Both are diarrhoeal pathogens that cause institutional outbreaks, contaminate the environment and aerosolise. They are resistant to alcohol, which results in confusion in hand hygiene education and conflict between some Australian guidelines. Recently released national isolation signage does not address this issue and some centres overseas have introduced ‘Contact Enteric Precautions' which make it clear that soap and water should be used. Both agents are resistant to disinfectants and persistence in the environment has been demonstrated after cleaning. Terminal disinfection with agents such as hydrogen peroxide may be advisable. Toilets have been shown to generate aerosols and the use of toilet lids to prevent this is debated. The cost of these two infections to the NHS is estimated at 260 million per annum in disruption to the system. Norovirus infection is not notifiable and hospital outbreaks and closures go unrecorded. It would appear that much of this could be solved by providing more single room accommodation with ensuite toilet facilities at every opportunity. Research into environmental monitoring, disinfection and design of toilets to eliminate aerosols is needed.