Primary care clinics can be a source of exposure to virulent Clostridium (now Clostridioides) difficile: An environmental screening study of hospitals and clinics in Dallas-Fort Worth region.

Jerry W Simecka,John Vitucci,Patricia Taylor,Frank Filipetto,Sushma Sharma,Joon-Hak Lee,Kimberly G Fulda,Phung Nguyen,Anna M Espinoza,Mark Pulse,Yung-Fu Chang

doi:10.1371/journal.pone.0220646

Abstract

C. difficile is an endospore-forming pathogen, which is becoming a common cause of microbial health-care associated gastrointestinal disease in the United States. Both healthy and symptomatic patients can shed C. difficile spores into the environment, which can survive for long periods, being resistant to desiccation, heat, and disinfectants. In healthcare facilities, environmental contamination with C. difficile is a major concern as a potential source of exposure to this pathogen and risk of disease in susceptible patients. Although hospital-acquired infection is recognized, community-acquired infection is an increasingly recognized health problem. Primary care clinics may be a significant source of exposure to this pathogen; however, there are limited data about presence of environmental C. difficile within clinics. To address the potential for primary care clinics as a source of environmental exposure to virulent C. difficile, we measured the frequency of environmental contamination with spores in clinic examination rooms and hospital rooms in Dallas-Fort Worth (DFW) area of Texas. The ribotypes and presence of toxin genes from some environmental isolates were compared. Our results indicate primary care clinics have higher frequencies of contamination than hospitals. After notification of the presence of C. difficile spores in the clinics and an educational discussion to emphasize the importance of this infection and methods of infection prevention, environmental contamination in clinics was reduced on subsequent sampling to that found in hospitals. Thus, primary care clinics can be a source of exposure to virulent C. difficile, and recognition of this possibility can result in improved infection prevention, potentially reducing community-acquired C. difficile infections and subsequent disease.

Highlights

Clostridium ( Clostridioides) difficile-associated disease (CDAD) is a leading cause of gastroenteritis associated deaths [1, 2] and becoming the most common microbial cause of health-care associated gastrointestinal disease in the United States [2, 3]
To address the potential for primary care clinics as a source of environmental exposure to virulent C. difficile, we measured the frequency of environmental contamination with spores in clinic examination rooms in Dallas-Fort Worth (DFW) area of Texas and compared them
Our results indicate primary care clinics have higher frequencies of contamination than that found in hospitals, but after notification and education, environmental contamination in clinics was reduced to that found in hospitals

Summary

Introduction

Clostridium ( Clostridioides) difficile-associated disease (CDAD) is a leading cause of gastroenteritis associated deaths [1, 2] and becoming the most common microbial cause of health-care associated gastrointestinal disease in the United States [2, 3]. C. difficile is an endospore-forming pathogen that can affect the gastrointestinal system primarily in at-risk patients [5]. Both asymptomatic and symptomatic patients can shed C. difficile spores into the environment, which are resistant to desiccation, heat, and various disinfectants [6, 7]. Production of exotoxins by vegetative C. difficile results in disruption of normal epithelial function and potentially severe diarrhea, leading to hospitalization and mortality, especially in elderly or immunocompromised patients

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