Our search yielded 9 studies and 1 research letter describing research into the efficacy of cleaning products against C difficile spores. Furthermore, there is no level I evidence to support the efficacy of any one chemical germicide for reducing the presence of spores in the environment. Of concern is the limited data linking choice of cleaning agent to rates of CDAD. 19Įvidence to support decision making about the use of environmental cleaners is weak. 3 Health Canada guidelines simply state that during an outbreak thorough environmental cleaning with a disinfectant of demonstrated effectiveness might be required. To reduce the number of spores in the environment, the Centers for Disease Control and Prevention recommend using chlorine-releasing products after meticulous cleaning to remove organic material. Reducing environmental sources of C difficile spores is likely to reduce C difficile colonization in hospitalized patients, which might in turn reduce rates of CDAD. 17 Additionally, C difficile spores have been shown to persist as a skin contaminant on patients even after their diarrhea resolves, which can serve as a reservoir for health care provider transmission to other patients. 3 Clostridium difficile spores have been isolated from numerous surfaces in patient rooms including commodes, bed railings, nursing call devices, and clothing. Spores produced by C difficile can persist in the environment for extended periods of time. Although the vegetative form of C difficile is fragile, it is capable of sporulating when environmental conditions do not support growth. Surfaces that become contaminated with feces can serve as reservoirs for C difficile. One of the prerequisites for CDAD is colonization with C difficile from an exogenous source. 11Ĭleaning products for environmental controlĬlostridium difficile bacteria are not part of the normal gastrointestinal flora. 10 The challenge of managing CDAD in the elderly has been described in a recent review article. 9 Preventing occurrence and recurrence of CDAD is an essential aspect of geriatric practice in an institutional setting and is linked to several core values of excellence in clinical care determined by the Task Force on the Future of Geriatric Medicine ( Box 1). 8 The loss of muscle strength during bed rest has been estimated to be as high as 5% daily, with lower limbs most affected. Negative effects of prolonged bed rest specific to the elderly can include disorientation, delirium, psychosocial dysfunction, disruption in social support, functional decline, and physical deconditioning. 2, 7 Isolation precautions, implemented to control the spread of CDAD, can result in prolonged bed rest. 5, 6 Patients experiencing CDAD while in hospital were almost twice as likely to be discharged to long-term care facilities. 5Ĭlostridium difficile–associated diarrhea is associated with increased lengths of hospital stay, costs, morbidity, and mortality among adult patients. While these increases have been seen in both pediatric and adult populations, elderly individuals have been disproportionately affected. 5 Incidence of CDI has also increased in Canada and Europe. 4 In the United States, the proportion of hospital discharges in which the patient record showed a discharge diagnosis code for CDI more than doubled between 20 the overall rate during this period was several-fold higher ( P =. 1 – 3 The Canadian Nosocomial Infection Surveillance Program reported an incidence of 4.74 cases of C difficile–associated diarrhea (CDAD) per 1000 patients admitted to hospital in Canada between January 1, 2007, and April 30, 2007. Clostridium difficile infection (CDI) is the most frequent cause of nosocomial infectious diarrhea.
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