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Searching for C. difficile at Hospital Admission: A Commentary in JAMA Internal Medicine

Posted on by CDC's Safe Healthcare Blog
Clifford McDonald, MD
Clifford McDonald, MD

Author: L. Clifford McDonald, MD
Associate Director for Science,
CDC Division of Healthcare Quality Promotion

Patients receiving medical care for something else can get an infection known as a healthcare-associated infection. The most common bacteria responsible for these infections in hospitals is Clostridium difficile (C. difficile). In a recent issue of JAMA Internal Medicine, my CDC colleague Alice Y. Guh, MD, MPH, and I have offered commentary on a study that investigated whether actively identifying and isolating patients who asymptomatically carry C. difficile (do not experience symptoms) can reduce the number of healthcare-associated C. difficile infections.

C. difficile can be spread in healthcare facilities between patients by contaminated surfaces and soiled hands when appropriate hygiene and infection control actions are not taken. Currently limiting spread of C. difficile in healthcare facilities involves infection control targeting patients with symptoms, such as isolating these patients in individual rooms. However, there is now increasing evidence that patients who carry C. difficile without symptoms can contribute to contamination and spread in healthcare facilities. Still few, if any, previous studies have demonstrated whether searching for asymptomatic carriers of C. difficile, and then isolating them, can further limit transmission and prevent infections.

The study found that detecting and isolating C. difficile carriers at the time of hospital admission was associated with a significant decrease in the incidence of healthcare-associated C. difficile infections. However, because there are inherent limitations in any single study on such a complex topic, the authors of this study called for additional studies to further investigate this strategy, a call we agree with in our commentary. Our commentary touches on additional factors that future studies should focus upon, including assessing the feasibility and challenges of routinely implementing active surveillance for C. difficile.

C. difficile was estimated to cause almost half a million infections in the United States in 2011. The results of this study are promising for not only increasing our understanding of how this organism is spread in healthcare facilities, but also casting light on potential supplemental measures to reduce healthcare-associated C. difficile infections. While we continue to further investigate this topic, it’s important to remember that even with what we know already, many C. difficile infections can be prevented by using current infection control recommendations and more careful antibiotic use. Visit CDC’s C. difficile website to find resources for patients and healthcare providers.

To access and read the commentary, visit the JAMA Internal Medicine website.

Posted on by CDC's Safe Healthcare Blog

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