Clostridioides difficile, commonly called C. diff, is a bacterium that can cause severe gastrointestinal disease, including colitis and life-threatening diarrhea. The infection occurs most often in people taking antibiotics, as these medications disrupt the normal balance of helpful gut bacteria, allowing C. diff to proliferate and release toxins. Because this organism is highly contagious and spreads easily, particularly in healthcare settings, contact precautions are definitively necessary. Enhanced precautions are required to contain the bacteria and prevent transmission to vulnerable individuals.
Understanding Clostridium Difficile Spores
The fundamental reason for stringent precautions is the bacterium’s ability to transform into a dormant, protective spore. When conditions in the environment become unfavorable, the C. diff cell produces a tough outer shell, making it resistant to drying, heat, and many common disinfectants. These spores are the primary infectious particle and allow the organism to survive for months on surfaces like bed rails, toilets, and medical equipment.
The spore state makes C. diff challenging to eliminate from a clinical environment. Unlike many other bacteria that are easily killed by routine cleaning and hand hygiene products, the spore remains viable and can be readily spread. Transmission occurs when these spores are shed in the feces of an infected person, contaminate surfaces, and are then inadvertently ingested by another individual. Upon reaching the intestinal tract, the spores germinate back into active, toxin-producing bacteria, starting the infection cycle anew.
Environmental Contact Precautions
The goal of contact precautions is to create a physical barrier that prevents spores from leaving the infected patient’s immediate environment. In a healthcare facility, a person with confirmed or suspected C. diff infection is typically placed in a private room with a dedicated toilet. This isolation minimizes the potential for environmental contamination in general areas.
Anyone entering the room must wear a disposable gown and gloves, which must be removed before exiting to contain any spores picked up from the patient or the room surfaces. Non-critical medical equipment, such as blood pressure cuffs and stethoscopes, should be dedicated solely for that patient’s use. All shared surfaces must be cleaned daily using a sporicidal disinfectant, a chemical agent specifically approved to kill C. diff spores. Chlorine-based products, often diluted to a concentration of 1,000 parts per million, are commonly used for this enhanced environmental cleaning.
The Necessity of Soap and Water
The most distinctive element of C. diff precautions involves hand hygiene, requiring a shift away from routine practices. Standard alcohol-based hand sanitizers are largely ineffective against the tough, protective C. diff spore. Alcohol kills vegetative bacteria cells by chemical means, but it cannot penetrate the spore’s shell.
Therefore, mechanical handwashing with soap and running water is mandated for anyone who has been in the room of an infected patient. The friction generated by rubbing the hands together under water physically removes the spores from the skin’s surface. The soap acts to help suspend the spores and debris, allowing the water to rinse them completely away. To ensure adequate removal, the mechanical washing process should last for 40 to 60 seconds.
Criteria for Discontinuing Isolation
Isolation measures are not indefinite and are typically lifted once the immediate risk of transmission has passed. The primary criterion for discontinuing C. diff contact precautions is the resolution of diarrhea. Specifically, the patient must have formed stools, meaning they have had fewer than three unformed bowel movements in a 24-hour period.
Some infection control guidelines recommend maintaining contact precautions for an additional 48 hours after the diarrhea has resolved to account for continued shedding of spores. This extended period is a safeguard against environmental contamination from residual spores on the skin or in the room. Even after isolation is lifted, patients must remain aware of the risk of recurrence, which happens in about 20% of cases and requires continued vigilance regarding hand hygiene and antibiotic use.