Clostridium difficile infection: Prevention and control
- L Clifford McDonald, MD
L Clifford McDonald, MD
- Senior Advisor for Science and Integrity
- Division of Healthcare Quality Promotion
- Centers for Disease Control and Prevention
- Preeta K Kutty, MD, MPH
Preeta K Kutty, MD, MPH
- Medical Epidemiologist, Clostridium difficile Prevention
- Division of Healthcare Quality Promotion
- Centers for Disease Control and Prevention
- Section Editors
- Stephen B Calderwood, MD
Stephen B Calderwood, MD
- Editor-in-Chief — Infectious Diseases
- Section Editor — Bacterial Infections
- Professor of Medicine (Microbiology and Immunobiology)
- Harvard Medical School
- Sheldon L Kaplan, MD
Sheldon L Kaplan, MD
- Editor-in-Chief — Pediatrics
- Section Editor — Pediatric Infectious Diseases
- Professor and Vice Chairman for Clinical Affairs
- Baylor College of Medicine
Clostridium difficile is the causative organism of antibiotic-associated colitis. It is the most common infectious cause of healthcare-associated diarrhea and a significant cause of morbidity and mortality among hospitalized patients . Most cases of C. difficile infection (CDI) in the United States are associated with inpatient or outpatient contact with a healthcare setting [2-4].
Development of CDI usually requires two events: disruption of the fecal microbiota (typically via exposure to antibiotics) and ingestion of spores via the fecal-oral route. C. difficile may be shed into the environment by individuals who are infected or colonized. High rates of colonization may occur among hospitalized adults, nursing home residents, and healthy infants [5-7].
C. difficile spores can be transmitted between patients via environmental surfaces and contaminated hands of healthcare personnel . Thus, efforts to prevent CDI must focus on two goals: reducing patient susceptibility to CDI and preventing organism transmission . Prevention of C. difficile transmission is especially challenging because the organism forms spores that can persist on environmental surfaces for months and are resistant to commonly used cleaning agents and alcohol-based hand gels .
Issues related to CDI prevention and control will be reviewed here. The pathophysiology, epidemiology, clinical manifestations, and treatment of CDI are discussed separately. (See related topics.)
PREVENTION OF CDI IN INDIVIDUAL PATIENTS
Preventing an initial episode — Strategies for preventing an initial episode of C. difficile infection include:
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- PREVENTION OF CDI IN INDIVIDUAL PATIENTS
- Preventing an initial episode
- Preventing a recurrent episode
- PREVENTION OF CDI IN POPULATIONS
- In healthcare settings
- - Infection control
- Prevention strategies
- - Early detection and isolation
- - Contact precautions
- - Hand hygiene
- - Environmental cleaning and disinfection
- - Role of chlorhexidine bathing
- Asymptomatic carriers
- - Antibiotic stewardship
- In community settings
- - Households
- - Childcare settings
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS