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Control of Clostridium (Clostridioides) difficile Infection in Long-Term Care Facilities/Nursing Homes

  • Amar KrishnaEmail author
  • Teena Chopra
Chapter

Abstract

Infection control measures are one of the cornerstones to prevent transmission of Clostridium (Clostridioides) difficile in a healthcare setting. However, implementing these measures in a long-term care facility (LTCF) setting presents with a unique set of challenges that are not seen in acute care hospitals. This chapter describes the various infection control measures that can be implemented to control C. difficile and the potential strategies to adapt them in an LTCF setting.

Keywords

Clostridium (Clostridioides) difficile Infection control Long-term care facility Hand hygiene Contact precautions Isolation Environmental disinfection 

References

  1. 1.
    Bobulsky GS, et al. Clostridium difficile skin contamination in patients with C. difficile-associated disease. Clin Infect Dis. 2008;46(3):447–50.CrossRefGoogle Scholar
  2. 2.
    Curry SR, et al. Use of multilocus variable number of tandem repeats analysis genotyping to determine the role of asymptomatic carriers in Clostridium difficile transmission. Clin Infect Dis. 2013;57(8): 1094–102.CrossRefGoogle Scholar
  3. 3.
    McFarland LV, et al. Nosocomial acquisition of Clostridium difficile infection. N Engl J Med. 1989;320(4):204–10.CrossRefGoogle Scholar
  4. 4.
    Samore MH, et al. Clinical and molecular epidemiology of sporadic and clustered cases of nosocomial Clostridium difficile diarrhea. Am J Med. 1996;100(1):32–40.CrossRefGoogle Scholar
  5. 5.
    McDonald LC, et al. Clinical practice guidelines for Clostridium difficile infection in adults and children: 2017 update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;66(7):e1–e48.CrossRefGoogle Scholar
  6. 6.
    Sethi AK, et al. Persistence of skin contamination and environmental shedding of Clostridium difficile during and after treatment of C. difficile infection. Infect Control Hosp Epidemiol. 2010;31(1):21–7.CrossRefGoogle Scholar
  7. 7.
    Freedberg DE, et al. Receipt of antibiotics in hospitalized patients and risk for Clostridium difficile infection in subsequent patients who occupy the same bed. JAMA Intern Med. 2016;176(12):1801–8.CrossRefGoogle Scholar
  8. 8.
    Manian FA, Meyer L, Jenne J. Clostridium difficile contamination of blood pressure cuffs: a call for a closer look at gloving practices in the era of universal precautions. Infect Control Hosp Epidemiol. 1996;17(3):180–2.CrossRefGoogle Scholar
  9. 9.
    Brooks SE, et al. Reduction in the incidence of Clostridium difficile-associated diarrhea in an acute care hospital and a skilled nursing facility following replacement of electronic thermometers with single-use disposables. Infect Control Hosp Epidemiol. 1992;13(2):98–103.CrossRefGoogle Scholar
  10. 10.
    Jernigan JA, et al. A randomized crossover study of disposable thermometers for prevention of Clostridium difficile and other nosocomial infections. Infect Control Hosp Epidemiol. 1998;19(7):494–9.CrossRefGoogle Scholar
  11. 11.
    Muto CA, et al. Control of an outbreak of infection with the hypervirulent Clostridium difficile BI strain in a university hospital using a comprehensive “bundle” approach. Clin Infect Dis. 2007;45(10):1266–73.CrossRefGoogle Scholar
  12. 12.
    Weiss K, et al. Multipronged intervention strategy to control an outbreak of Clostridium difficile infection (CDI) and its impact on the rates of CDI from 2002 to 2007. Infect Control Hosp Epidemiol. 2009;30(2):156–62.CrossRefGoogle Scholar
  13. 13.
    Cassir N, et al. A regional outbreak of Clostridium difficile PCR-ribotype 027 infections in southeastern France from a single long-term care facility. Infect Control Hosp Epidemiol. 2016;37(11):1337–41.CrossRefGoogle Scholar
  14. 14.
    Simor AE, et al. Clostridium difficile in long-term-care facilities for the elderly. Infect Control Hosp Epidemiol. 2002;23(11):696–703.CrossRefGoogle Scholar
  15. 15.
    Archbald-Pannone L. Survey of C. difficile-specific infection control policies in local long-term care facilities. Int J Clin Med. 2014;5(7):414–9.CrossRefGoogle Scholar
  16. 16.
    Jump RL, Donskey CJ. Clostridium difficile in the long-term care facility: prevention and management. Curr Geriatr Rep. 2015;4(1):60–9.CrossRefGoogle Scholar
  17. 17.
    Quinn LK, Chen Y, Herwaldt LA. Infection control policies and practices for Iowa long-term care facility residents with Clostridium difficile infection. Infect Control Hosp Epidemiol. 2007;28(11):1228–32.CrossRefGoogle Scholar
  18. 18.
    AHCA. American Health Care Association 2012 staffing report. http://www.ahcancal.org/research_data/staffing/Documents/2012_Staffing_Report.pdf. Accessed 14 Apr 2019.
  19. 19.
    Chopra T, Goldstein EJ. Clostridium difficile infection in long-term care facilities: a call to action for antimicrobial stewardship. Clin Infect Dis. 2015;60(Suppl 2):S72–6.CrossRefGoogle Scholar
  20. 20.
    Davies KA, et al. Underdiagnosis of Clostridium difficile across Europe: the European, multicentre, prospective, biannual, point-prevalence study of Clostridium difficile infection in hospitalised patients with diarrhoea (EUCLID). Lancet Infect Dis. 2014;14(12):1208–19.CrossRefGoogle Scholar
  21. 21.
    Krishna A, et al. Prevalence of Clostridium difficile infection in acute care hospitals, long-term care facilities, and outpatient clinics: is Clostridium difficile infection underdiagnosed in long-term care facility patients? Am J Infect Control. 2017;45(10):1157–9.CrossRefGoogle Scholar
  22. 22.
    Simor AE. Diagnosis, management, and prevention of Clostridium difficile infection in long-term care facilities: a review. J Am Geriatr Soc. 2010;58(8):1556–64.CrossRefGoogle Scholar
  23. 23.
    Johnson S, et al. Prospective, controlled study of vinyl glove use to interrupt Clostridium difficile nosocomial transmission. Am J Med. 1990;88(2):137–40.CrossRefGoogle Scholar
  24. 24.
    Larson E, et al. Lack of care giver hand contamination with endemic bacterial pathogens in a nursing home. Am J Infect Control. 1992;20(1):11–5.CrossRefGoogle Scholar
  25. 25.
    Perry C, Marshall R, Jones E. Bacterial contamination of uniforms. J Hosp Infect. 2001;48(3):238–41.CrossRefGoogle Scholar
  26. 26.
    Pittet D, Mourouga P, Perneger TV. Compliance with handwashing in a teaching hospital. Infection Control Program. Ann Intern Med. 1999;130(2):126–30.CrossRefGoogle Scholar
  27. 27.
    Oughton MT, et al. Hand hygiene with soap and water is superior to alcohol rub and antiseptic wipes for removal of Clostridium difficile. Infect Control Hosp Epidemiol. 2009;30(10):939–44.CrossRefGoogle Scholar
  28. 28.
    Gordin FM, et al. Reduction in nosocomial transmission of drug-resistant bacteria after introduction of an alcohol-based handrub. Infect Control Hosp Epidemiol. 2005;26(7):650–3.CrossRefGoogle Scholar
  29. 29.
    Kundrapu S, et al. More cleaning, less screening: evaluation of the time required for monitoring versus performing environmental cleaning. Infect Control Hosp Epidemiol. 2014;35(2):202–4.CrossRefGoogle Scholar
  30. 30.
    Jury LA, et al. Effectiveness of routine patient bathing to decrease the burden of spores on the skin of patients with Clostridium difficile infection. Infect Control Hosp Epidemiol. 2011;32(2):181–4.CrossRefGoogle Scholar
  31. 31.
    Kim KH, et al. Isolation of Clostridium difficile from the environment and contacts of patients with antibiotic-associated colitis. J Infect Dis. 1981;143(1):42–50.CrossRefGoogle Scholar
  32. 32.
    Fawley WN, Wilcox MH. Molecular epidemiology of endemic Clostridium difficile infection. Epidemiol Infect. 2001;126(3):343–50.CrossRefGoogle Scholar
  33. 33.
    Fawley WN, et al. Efficacy of hospital cleaning agents and germicides against epidemic Clostridium difficile strains. Infect Control Hosp Epidemiol. 2007;28(8):920–5.CrossRefGoogle Scholar
  34. 34.
    Mayfield JL, et al. Environmental control to reduce transmission of Clostridium difficile. Clin Infect Dis. 2000;31(4):995–1000.CrossRefGoogle Scholar
  35. 35.
    Kaatz GW, et al. Acquisition of Clostridium difficile from the hospital environment. Am J Epidemiol. 1988;127(6):1289–94.CrossRefGoogle Scholar
  36. 36.
    McMullen KM, et al. Use of hypochlorite solution to decrease rates of Clostridium difficile-associated diarrhea. Infect Control Hosp Epidemiol. 2007;28(2):205–7.CrossRefGoogle Scholar
  37. 37.
    Sitzlar B, et al. An environmental disinfection odyssey: evaluation of sequential interventions to improve disinfection of Clostridium difficile isolation rooms. Infect Control Hosp Epidemiol. 2013;34(5):459–65.CrossRefGoogle Scholar
  38. 38.
    Boyce JM, et al. Monitoring the effectiveness of hospital cleaning practices by use of an adenosine triphosphate bioluminescence assay. Infect Control Hosp Epidemiol. 2009;30(7):678–84.CrossRefGoogle Scholar
  39. 39.
    Munoz-Price LS, et al. Decreasing operating room environmental pathogen contamination through improved cleaning practice. Infect Control Hosp Epidemiol. 2012;33(9):897–904.CrossRefGoogle Scholar
  40. 40.
    US GRADE Network. Approach and implications to rating the quality of evidence and strength of recommendations using the GRADE methodology, 2015. Available at: http://www.gradeworkinggroup.org/.

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Detroit Medical Center/Wayne State UniversityDetroitUSA

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