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New Guidelines for Prevention of Infectious Diarrhea

Experts offer strategies to reduce prevalence of C. difficile in hospitals

With Clostridium difficile rivaling methicillin-resistant Staphylococcus aureus (MRSA) as the most common bacteria to cause health care-associated infections, new expert guidelines encourage health care institutions to implement and prioritize prevention efforts for C. difficile-associated infectious diarrhea.

The guidelines are available in the June issue of Infection Control and Hospital Epidemiology.

The new practice recommendations are a part of “Compendium of Strategies to Prevent Healthcare-Associated Infections in Acute Care Hospitals: 2014 Updates,” a collaborative effort led by the Society for Healthcare Epidemiology of America, the Infectious Diseases Society of America, the American Hospital Association, the Association for Professionals in Infection Control and Epidemiology, and The Joint Commission. The new release updates a 2008 Compendium publication.

To help combat C. difficile infections, experts recommend creating a multidisciplinary approach that enlists a range of hospital personnel, including leadership, health care professionals, laboratory personnel, pharmacy technicians, environmental services staff, and IT professionals to collaborate and implement effective interventions. Recommended strategies for hospitals and other acute-care settings include the following:

  • Encourage appropriate antimicrobial use and stewardship. This includes both avoiding antimicrobial exposures if a patient does not require treatment and selecting antibiotics that pose a lower risk for developing C. difficile infection, when possible. This is distinct from a formal antimicrobial stewardship program, which remains a special approach to antibiotic use.
  • Use contact precautions. Hospitals are urged to treat patients with C. difficile in separate rooms from the general patient population and to require health care professionals to wear gloves and gowns whenever providing care to someone with confirmed C. difficile infection. It is also recommended that health care professionals use dedicated patient-care items and equipment in this care.
  • Practice hand hygiene. Because indirect transmission by health care professionals may be a major route by which patients acquire C. difficile, implementing a protocol on hand hygiene is a crucial part of a successful prevention program, according to the guidelines. C. difficile differs from other drug-resistant bugs, such as MRSA and vancomycin-resistant Enterococcus (VRE), because it produces spores that are resistant to alcohol-based products. This makes wearing gloves and washing hands with soap and water before every encounter with infected patients extremely important. Hand hygiene protocols should be periodically measured to ensure compliance.
  • Ensure environmental decontamination. The education of environmental support staff, including cleaning crews, is crucial to maintaining effective disinfection. This includes proper cleaning of patient rooms and furnishings, equipment, and surfaces touched by health care professionals and patients.
  • Conduct surveillance and performance measures. Implementing a laboratory-based alert system to provide immediate notification of newly diagnosed patients to clinical personnel will help frontline staff monitor for outbreaks. In addition, creating reporting systems to capture the burden of the infection at a health care facility and to assess the efficacy of prevention interventions, such as hand hygiene and contact precautions, will help health care institutions to improve efforts.

The new guidelines also note several areas that require more research before recommendations can be made. These include:

  • Requiring the use of gowns and gloves by family members and other visitors
  • Prescribing probiotics as a treatment against C. difficile
  • Using no-touch disinfection technology
  • Restricting the use of gastric acid suppressants

Source: SHEA; May 6, 2014.

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