Clostridioides difficile (C. diff) is a bacterium capable of causing severe diarrhea and inflammation of the colon, a condition known as colitis. This microorganism represents a significant concern within healthcare environments, contributing to a notable portion of healthcare-associated infections.
How C. diff is Transmitted
C. diff is primarily transmitted through the fecal-oral route, meaning spores from feces are ingested. The bacterium forms spores, which are highly resilient structures that can survive on environmental surfaces for extended periods, sometimes for months. These spores are resistant to many common disinfectants and can contaminate various items in healthcare settings.
Spores can spread through direct contact with contaminated surfaces, such as doorknobs, bedrails, toilets, and shared medical equipment. For instance, studies show that environmental contamination is higher in rooms of patients with active C. diff infection, ranging from 9% to 50% of rooms. Healthcare personnel’s hands can become contaminated after caring for infected patients, with contamination rates ranging from 14% to 59% when gloves are not worn.
Transmission also occurs through direct contact with infected individuals. If hands become contaminated with spores and are not properly cleaned, the spores can be transferred to other surfaces or directly to another person. Patient hands themselves can become contaminated with C. diff at a rate of up to 32%, contributing to self-infection or further environmental contamination.
Why Specific Precautions are Necessary
The persistent nature of C. diff spores necessitates specific infection control measures to limit their spread in healthcare environments. Rigorous hand hygiene is a cornerstone of prevention, with soap and water being more effective than alcohol-based hand sanitizers against C. diff spores. While alcohol-based sanitizers are effective against many germs, they do not kill C. diff spores, primarily facilitating their removal.
Thorough environmental cleaning using sporicidal agents, such as bleach-based cleaners, is also important to eliminate spores from surfaces. This includes frequent cleaning of high-touch surfaces like bedrails and bathroom fixtures. Dedicated or disposable medical equipment should be used for C. diff patients, and reusable equipment must be cleaned and disinfected between patients.
In healthcare settings, patients with suspected or confirmed C. diff infection are typically placed on contact precautions. This involves healthcare workers wearing personal protective equipment (PPE), such as gloves and gowns, upon entering the patient’s room. These measures aim to reduce the transfer of spores to healthcare providers’ hands and clothing, preventing further dissemination.
Distinguishing C. diff Transmission from Other Germs
C. diff transmission differs significantly from airborne or droplet-based spread, which are common for many respiratory pathogens. Airborne transmission involves infectious agents, often in very small particles (typically less than 5 micrometers), remaining suspended in the air for extended periods and traveling long distances, sometimes more than 6 feet. Examples of diseases spread this way include tuberculosis and measles.
Droplet transmission occurs when larger respiratory droplets, usually greater than 5 micrometers, are expelled through coughing, sneezing, or talking. These droplets generally travel short distances, typically settling within 3 to 6 feet of the source, before falling out of the air. Influenza and the common cold are often spread via droplets.
C. diff, unlike these respiratory pathogens, is not typically spread through the air or via large droplets expelled from the respiratory tract. Its spore-forming nature means that transmission relies on physical contact with contaminated surfaces or individuals, followed by ingestion of the spores. This fundamental difference in transmission mechanisms underscores why specific contact precautions and rigorous environmental cleaning are necessary for C. diff, rather than airborne or droplet precautions.