ASID/AICA position statement - Infection control guidelines for patients with Clostridium difficile infection in healthcare settings

Since 2000 there has been an increase in the rates of Clostridium difficile infection (CDI) in many healthcare facilities in the United States, Canada and Europe. This increase is associated with an epidemic strain of C. difficile and this strain (PCR ribotype 027) has recently been identified in Australia. All healthcare services should have in place an optimal evidence-based program for CDI prevention and control. Management principles include the following. • All healthcare organisations, including residential aged care facilities, must give CDI prevention and control the highest priority, even if the prevailing incidence of CDI is low. • Surveillance should be integrated into quality improvement programs to optimise prevention, control and clinical care of CDI. • Antimicrobial stewardship programs aimed at minimising the frequency and duration of antibiotic use and promoting a narrow spectrum antibiotic policy should be implemented. • Emphasis should be placed on compliance with hand disinfection using alcohol-based hand rub and glove use for CDI patient care to minimise spore contamination. • Contact precautions should be in place for symptomatic CDI patients, including the donning of gowns/aprons and gloves on entry to patient rooms. • The use of sporocidal environmental cleaning and disinfection in high-risk areas such as toilets, bathrooms, and CDI patient rooms should be implemented. There should be the limination of other potential fomites by either using disposable equipment or ensuring that equipment is adequately cleaned and disinfected before re-use. • Education of all healthcare staff, patients and visitors about C. difficile disease, its prevention and management should be implemented.