cdiff.eu | Clostridium difficile

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  • 3.1: The bacterium
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  • 3.3: Diagnostics
  • 3.4: Outbreak control
• 4: EACCAD
  • 4.1: Who we are
  • 4.2: Summary of the project
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Outbreak control

 Clostridium difficile-associated disease (CDAD) is a common nosocomial infection and usually presents with diarrhoea after antimicrobial therapy. Other factors that may also predispose for CDAD include age, duration of hospital stay, malignancies and chemotherapy, renal failure, underlying gastrointestinal diseases, previous intestinal surgery, diabetes mellitus, and chronic obstructive pulmonary disease. During CDAD large numbers of CD spores may become excreted by affected patients. Transmission of CD occurs mainly via contact of contaminated health care workers to patients  or directly by patient-to-patient transmission. Spores of CD may survive in the environment for very long periods of time and also show resistance to various surface disinfection substances. By this, the route “patient – environment – patient” may also be possible for nosocomial CD transmission. Airborne transmission is unlikely to occur based on the current review of the literature, but new studies are needed using more sophisticated techniques for air sampling.

 Once CDAD is diagnosed in a patient, immediate implementation of appropriate infection control measures is mandatory in order to prevent further CD spread within the hospital. Up to now, there are no European guidelines that deal with this important topic. However, a guidance document is currently in preparation (Ralf-Peter Vonberg, Ed Kuijper, Mark Wilcox, Petra Gastmeier et al) which contains  evidence based recommendations for a) proper hand hygiene, b) the use of protective clothing for personnel, c) screening, surveillance and isolation of patients, d) environmental and disinfection issues, and e) the use of medical devices when caring for patients suffering from CDAD. In addition, specific recommendations are made when dealing with nosocomial CDAD outbreaks.   Further information is avialable via the coordinator of EACCAD.         

National and international guidelines are available via: 

• USA Centers for Disease Control and Prevention (C. difficile): http://www.cdc.gov/ncidod/dhqp/id_Cdiff.html 
• Massachusetts Department of Public Health - Division of Epidemiology and Immunization. Infection control guidelines for long-term care facilities. http://www.mass.gov/dph/cdc/ 
• Werkgroep Infectie Preventie (WIP). http://www.wip.nl/UK/Default.htm 
• RIVM, The Netherlands (Center for Infectious Disease control) http://www.rivm.nl/en/healthanddisease/infectiousdiseases/ 
  National Dutch document for oubreak control: download here. 
• Ministere de la Sante et des Solidarites: Direction Generale de la Sante. Relatif à la maîtrise de la diffusion des infections à Clostridium difficile dans les établissements de senté francais. http://www.sante.gouv.fr  
• Réseau d´Alerte d´Investigation et de Surveillance des Infections Nosocomiales. Conduite à tenir: diagnostic, investigation, surveillance, et principes de prévention et de maîtrise des infections à Clostridium difficile. http://cclin-sudest.chu-lyon.fr/Alertes/conduite_clostridium_difficile.pdf 2006  
• Belgium Infection Control Society : http://www.belgianinfectioncontrolsociety.be/  
  
• Health Protection Agency, C. difficile: http://www.hpa.org.uk/infections/topics_az/clostridium_difficile/default.htm
  
  Institut National de Santé Publique du Québec. Prévention et contrôlle de la diarrhée nosocomiale associée au Clostridium difficile au Québec. ( http://www.inspq.qc.ca/http://www.inspq.qc.ca/pdf/publications/362-CDifficile-LignesDirectrices-3eEdition pdf 2005)