Horizontal Healthcare Hygienic Practices Can Mitigate Hospital-Onset Clostridioides difficile Infection

By Kelly M. Pyrek

Following a schematic of horizontal healthcare hygienic practices that pairs environmental hygiene with hand hygiene, aided by proper cleaning and the use of appropriate liquid chemical disinfection can fight hospital-onset Clostridioides difficile infection (HO-CDI), say researchers who have recently published a paper outlining this simple yet effective strategy (Carling, et al. 2023).

The authors remind us that despite attempts to use dilute bleach during CDI outbreaks, “efforts to effectively mitigate environmental transmission of Clostridiodes difficile (CD) spores in endemic settings has been ineffective,” according to studies. What does work, the researchers say, are new insights into the healthcare epidemiology of HO-CDI and updated approaches to mitigating environmental transmission.

Data from the Centers for Disease Control and Prevention (CDC) showed that CDI had been decreasing prior to the COVID-19 pandemic, but it, along with other healthcare-associated infections, has escalated.

As Carling, et al. (2023) explain, “In the United States, CDI rates had been showing a gradual decrease during the decade prior to the COVID pandemic, primarily due to decreases in HO-CDI. Several factors would appear to have contributed to the declining incidence including antimicrobial stewardship, better diagnostic stewardship, and reimbursement-negative incentive programs. While some facilities experienced increases in HO-CDI early in the COVID pandemic, recent more extensive studies have failed to document a significant trend in CDI rates.”

“The CDI rate has plateaued and perhaps is no longer decreasing, but there was a benefit to the antimicrobial stewardship efforts over a four- or five-year period where you watched the general national numbers drift slightly downwards," Philip Carling says. "Not gigantically, but certainly significantly, slowly, downward. I'm a very strong supporter of antimicrobial stewardship but the problem I see is that the impact on hospital-acquired C. diff may have reached a ceiling of benefit. Most hospitals are not doing too badly with inpatient antimicrobial use, and they've come a long way in the last decade. And so, I think we might not see as much additional benefit over time. Since the pandemic, it’s been all over the place; some hospitals have increases while a few saw decreases, and some facilities remained about the same. But nobody was keeping track during the pandemic, so the data was spotty and understandably so. I think the pandemic stalled progress; I think there was probably a little decrease in C. diff acquisition because of all the isolation precautions that were being taken in hospitals. When COVID became less overwhelming, and patients in isolation were better managed, you likely could detect the impact on CDI.”

Read further from the October 2023 issue HERE