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Infection control measures to limit the spread of Clostridium difficile

  1. R.-P. Vonberg1,
  2. E. J. Kuijper2,
  3. M. H. Wilcox3,
  4. F. Barbut4,
  5. P. Tüll5,
  6. P. Gastmeier1,
  7. on behalf of the European C. difficile-Infection Control Group and the European Centre for Disease Prevention and Control (ECDC)1,
  8. P. J. Van Den Broek2,
  9. A. Colville6,
  10. B. Coignard7,
  11. T. Daha8,
  12. S. Debast9,
  13. B. I. Duerden10,
  14. S. Van Den Hof11,
  15. T. Van Der Kooi11,
  16. H. J. H. Maarleveld2,
  17. E. Nagy12,
  18. D. W. Notermans11,
  19. J. O’Driscoll13,
  20. B. Patel14,
  21. S. Stone15,
  22. C. Wiuff16

Article first published online: 11 APR 2008

DOI: 10.1111/j.1469-0691.2008.01992.x

Issue

Clinical Microbiology and Infection

Clinical Microbiology and Infection

Special Issue: Infection control measures to limit the spread of Clostridium difficile

Volume 14, Issue Supplement s5, pages 2–20, May 2008

Additional Information

How to Cite

Vonberg, R.-P., Kuijper, E. J., Wilcox, M. H., Barbut, F., Tüll, P., Gastmeier, P., on behalf of the European C. difficile-Infection Control Group and the European Centre for Disease Prevention and Control (ECDC), Van Den Broek, P. J., Colville, A., Coignard, B., Daha, T., Debast, S., Duerden, B. I., Van Den Hof, S., Van Der Kooi, T., Maarleveld, H. J. H., Nagy, E., Notermans, D. W., O’Driscoll, J., Patel, B., Stone, S. and Wiuff, C. (2008), Infection control measures to limit the spread of Clostridium difficile. Clinical Microbiology and Infection, 14: 2–20. doi: 10.1111/j.1469-0691.2008.01992.x

Author Information

  1. 1

    Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Hannover, Germany

  2. 2

    Leiden University Medical Centre, Leiden, The Netherlands

  3. 3

    Department of Microbiology, Leeds Teaching Hospitals and University of Leeds, Leeds, UK

  4. 4

    Unité d’Hygiène et de Lutte contre les Infections Nosocomiales, Hôpital Saint-Antoine, Paris, France

  5. 5

    European Centre for Disease Prevention and Control (ECDC), Stockholm, Sweden

  6. 6

    Royal Devon and Exeter Hospital NHS Foundation Trust, Exeter, UK

  7. 7

    Institut de Veille Sanitaire, Saint-Maurice, France

  8. 8

    The Dutch Working Party Infection Control, Leiden

  9. 9

    Meander Medical Centre, Amersfoort, The Netherlands

  10. 10

    Department of Health, London, UK

  11. 11

    Centre for Infectious Disease Control Netherlands, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands

  12. 12

    Institute of Clinical Microbiology, Faculty of Medicine, University of Szeged, Szeged, Hungary

  13. 13

    Stoke Mandeville Hospital, Stoke Mandeville, Buckinghamshire, UK

  14. 14

    Health Protection Agency, London, UK

  15. 15

    Academic Department of Geriatric Medicine, Hampstead Campus, Royal Free and University College Medical School, London, UK

  16. 16

    Health Protection Scotland, Glasgow, UK

*Corresponding author and reprint requests: R.-P. Vonberg, MD, Institute for Medical Microbiology and Hospital Epidemiology, Medical School Hannover, Carl-Neuberg-Str. 1, D-30625 Hannover, Germany E-mail: Vonberg.Ralf@MH-Hannover.DE

Publication History

  1. Issue published online: 11 APR 2008
  2. Article first published online: 11 APR 2008

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Keywords:

  • Clostridium difficile;
  • evidence-based guidelines;
  • infection control measures

Abstract

Clostridium difficile-associated diarrhoea (CDAD) presents mainly as a nosocomial infection, usually after antimicrobial therapy. Many outbreaks have been attributed to C. difficile, some due to a new hyper-virulent strain that may cause more severe disease and a worse patient outcome. As a result of CDAD, large numbers of C. difficile spores may be excreted by affected patients. Spores then survive for months in the environment; they cannot be destroyed by standard alcohol-based hand disinfection, and persist despite usual environmental cleaning agents. All these factors increase the risk of C. difficile transmission. Once CDAD is diagnosed in a patient, immediate implementation of appropriate infection control measures is mandatory in order to prevent further spread within the hospital. The quality and quantity of antibiotic prescribing should be reviewed to minimise the selective pressure for CDAD. This article provides a review of the literature that can be used for evidence-based guidelines to limit the spread of C. difficile. These include early diagnosis of CDAD, surveillance of CDAD cases, education of staff, appropriate use of isolation precautions, hand hygiene, protective clothing, environmental cleaning and cleaning of medical equipment, good antibiotic stewardship, and specific measures during outbreaks. Existing local protocols and practices for the control of C. difficile should be carefully reviewed and modified if necessary.

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