For any of our readers living in Canada, many of you have no doubt been blindsided by the barrage of news stories emanating from the Ontario healthcare facilities that are currently in the clutches of Clostridium difficile outbreaks. For this reason, we are breaking from our scheduled topic of discussion to address this infection prevention and control issue that’s dominating the news.
In the writing of this blog I’m going to skip the basics in the assumption that many of our readers are already familiar with this information. However, if you’re not, please feel free to review the information found in the following links:
Clostridium difficile Fact Sheet
Testing, Surveillance & Management of Clostridium difficile in All Health Care Settings
Let’s jump directly into the discussion that is of direct interest to The Clean Freaks. How do we go about cleaning and disinfecting the environment to adequately remove C. diff spore contamination?
Clearly the most important or unique aspect of cleaning and disinfecting an environment that is potentially contaminated with C. diff is the fact that Clostridium difficile is most commonly found in its very resistant spore form when deposited in the environment. Essentially, this spore acts like a coat of armour on the bacteria protecting it from various environmental hazards including many cleaning and disinfecting chemicals. This has major implications on the practices and particularly the disinfectant products that need to be utilized to render the surfaces safe. Unlike vegetative bacteria or viruses, typical hospital grade disinfectants are simply not effective for the disinfection of C. diff spores. For this reason, specialized agents must be employed to penetrate the spore and kill the bacteria.
So when should we implement these specialized spore killers? How aggressive should we be with their use?
Some would argue that we should take a pro-active or preventative approach with C. diff as we do with many other pathogens. That is, implement a disinfectant for daily use throughout a healthcare facility that effectively kills C. diff, thus potentially preventing the deadly and costly outbreaks before they even begin. While I understand this way of thinking and would certainly agree that this is what we should work towards, I do not believe we are at a point where this approach is feasible. This is namely because the current commercially available sporicidal agents are simply too aggressive for day-to-day usage throughout an entire facility. By this, I mean they typically require heightened safety precautions and their prolonged use will likely result in the premature degradation of some surfaces and sensitive equipment. Certainly, neither of these side-effects would be considered desirable. Therefore, I suggest an alternative option. One that consists of a more targeted, or task oriented stepwise approach. Instead of recklessly bathing a facility with highly concentrated disinfectant solutions on a daily basis regardless of outbreak status, I propose addressing only those areas where C. diff is most likely to be present or is suspected to be present with these sporicidal agents. For example, scientific studies have shown that the bathrooms of C. diff isolation rooms are the most highly contaminated areas. Therefore, the usage of a sporicidal agent in that confined space makes sense as a first level intervention. Or perhaps if a facility is battling endemic C. diff, we contemplate cleaning and disinfecting all bathrooms throughout the facility in this manner in an effort to reduce the potential bio-burden that may be present. Lastly, should the unfortunate situation arise where a cluster or outbreak of C. diff occurs do we contemplate aggressively blitzing the affected unit/ward or entire facility with the sporicidal agent. In following this approach, the intent is to minimize the potential for negative consequences that could result from the misuse of sporicidal agents and instead get the greatest return on our investment from their usage.
Lucky for me, it just so happens that some of the leading infection prevention and control experts also agree with this approach (See earlier link to PIDAC C. diff Management Guideline). So how do you clean and disinfect your facility when C. diff may be an issue?
Hasta la vista!
Lee- The Germinator