Pearls in Infection Control for Clostridium difficile Infections in Healthcare Facilities

Abstract

Prevention of Clostridium difficile infection (CDI) is a complex task; adequate and sustained success is difficult to obtain. Focus on prevention has to start by analyzing the targeted patient population; the most important risk factors for development of CDI are previous exposure to antibiotics, hospitalization and advanced age. Thus, limiting antibiotic exposure and over exposure with an antibiotic stewardship program that employs combined strategies reducing the number of doses and spectrum is essential. Reducing hospital exposure by ambulatory care and short-stay procedures aids in this task, but, when hospitalized, patients rely solely on healthcare personnel commitment to hand hygiene to reduce transport of spores, and on environmental staff for providing a safe environment by proper decontamination of hospital surfaces and equipment. Age as a risk factor is not modifiable, but what is modifiable is the environment where elderly patients are cared for, in which individual rooms and proper disposal of bed pans, diapers and toilet disinfection are fundamental. Using contact precautions limits dissemination of potential infecting spores by reducing carriage to uninfected patients on hands and clothes of healthcare personnel. Probiotics studies are continuously providing more robust information on their role in primary and secondary prevention and are now more frequently used in hospitals. Vaccination will play a strong role in the near future by targeting key patients who are likely to be continuously exposed to a healthcare environment. A summarized message and approach of this text is shown in Table 1.