Minimizing C. difficile Risk in Long Term Care Facilities

Targeted Clostridium difficile (C. difficile) infection and prevention control guidelines agree on several detection and managerial recommendations, according to a new assessment.

Researchers used publicly available national or organizational guidelines related to C. difficile infection and prevention controls published between 2000 and 2015 to outline the strengths and limitations of the evidence reported. The researchers noted papers from 28 countries including North America, the Western Pacific, Europe, and South America. Because of the high incidence of C. difficile infection, health care professionals should be mindful of the most current guidelines, in addition to the strengths and limitations of the evidence.

The 10 identified infection and prevention control areas supported antimicrobial use as essential, citing high quality evidence. The researchers wrote that antibiotics, probiotics, and gastric acid suppressants were important factors in C. difficile infection prevention. While antibiotics and probiotics can curbs patients susceptibility for infection, gastric acid suppressants was an unresolved issue with no official C. difficile infection resolution.

The researchers also identified five “strong” recommendations from their meta analysis:

Effective environment cleaning, including medical equipment: All documents highlighted the importance of cleaning to prevent C. difficile transmission, and chlorine based and sporicidal agents were the most commonly recommended methods. Newer technologies — such as ultraviolet light or hydrogen peroxide vapors – were found in the papers and classified by the researchers as an unresolved issue.

Case isolation: Isolating cases were recommended through the use of en suite bathrooms or individual bedpans in addition to using patients with C. difficile infection. Maintaining this separation until diarrheal episodes subsided, usually for a period of 48 hours, was an effective way to reduce spore spread and minimize patient risk. The researchers did add, though, that this method could produce managerial difficulties and costs in a health care facility.

Use of personal protective equipment: While the use of protective equipment such as gloves and gowns was strongly recommended for health care workers as a precautionary measure, the use of such items for visitors was recommended with unknown actual benefit, the study authors explained.

Surveillance: Surveillance was recommended for long term care facilities with most of the guidelines including a statement or clarifications that discouraged the conducting of test of cures. The swift detection of C. difficile infection could lead to more quickly alleviating the burden of infection, the study authors said.

Education: More than half of the papers identified by the study authors recommended some form of instructions, information, training, educational campaigns or workshops for health care facility workers, patients, or visitors. Though, the researchers added that there was a study reporting a gap between the knowledge of C. difficile infection among health care facility workers and the quality of educational materials available for patients.

“This review of guidelines highlights the need for greater international harmonization in the assessment of the evidence underpinning infection prevention and control recommendations for C. difficile infection and for more research,” the authors concluded in their study, “Infection prevention and control of Clostridium difficile: a global review of guidelines, strategies, and recommendations,” which was published in the Journal of Global Health.

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