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Infection Prevention Q & A Part 5–C. diff Cleaning

Infection Prevention Q & A Part 5--C. diff Cleaning

Question-What is the best cleaning procedure and product to use when cleaning C. diff patient’s room?
Answer-The control of Clostridium difficile (C. diff) within an isolated patient’s room is essential for current and future patients. It’s the out of control nature of watery diarrhea that allows C. diff to spread so fast in a hospital. Although a small number of patients come into the hospital with C. diff spores in their bodies, many more ingest the germ through oral-fecal contamination, meaning traces of one patient’s feces enter another patient’s mouth. How could such a thing happen? The only answer is inadequate cleaning. Patients pick up the C. diff spores off contaminated bedrails, IV poles, tables, and other surfaces, virtually anywhere their hands can reach. Then they touch their lips, or touch their food and swallow C.diff along with their dinner roll. Caregivers unwittingly carry C. diff spores on their hands, uniforms, and equipment from patient to patient.
Peter Eisler writes in an article titled, “One Bacteria, 30,000 Deaths” in USA TODAY, August 16, 2012, “A USA TODAY investigation shows that C. diff is far more prevalent than federal reports suggest. The bacteria is linked in hospital records to more than 30,000 deaths a year in the United States— about twice federal estimates and rivaling the 32,000 killed in traffic accidents. It strikes about a half-million Americans a year.’
“Yet despite a decade of rising C. diff rates, health care providers and the government agencies that oversee them have been slow to adopt proven strategies to reduce the infections, resulting in tens of thousands of deaths and illnesses that could have been prevented, the investigation shows.”

Here is a list of 13 strategies (some original with me and others borrowed from “best practices”) that could be adopted by every hospital treating patients with this potentially deadly pathogen:

  1. The CDC says, “Because alcohol does not kill Clostridium difficile spores, use of soap and water is more efficacious than alcohol-based hand rubs. However, early experimental data suggest that, even using soap and water, the removal of C. difficile spores is more challenging than the removal or inactivation of other common pathogens.” Consider removing alcohol-based hand sanitizers from the C. diff patient’s room. If the ABHS is not removed, you should use a sign on the container stating, “This product does not inactivate C. diff bacterial spores. Instead, wash hands with soap and water for at least 25 seconds.”
  2. Preventing contamination of the hands via glove use remains the cornerstone for preventing Clostridium difficile transmission via the hands of healthcare workers, states the CDC.
  3. Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently. Items, such as Johnny mops and a holder, should be dedicated to the isolated patient’s room and discarded at discharge or transfer.
  4. Because C. difficile spores resist killing by usual hospital disinfectants, a U.S. Environmental Protection Agency (EPA)-registered disinfectant with a C. diff sporicidal claim should be used to augment physical cleaning. When choosing a disinfectant with a C. diff claim, use the disinfectant that is least corrosive, yet has a C. diff-kill claim (3 minute contact time is optimal).  Be sure to observe labeled contact times for a surface to remain wet.
  5. At least one hospital has been able to control the spread of C. diff by implementing a team of well-trained and dedicated ES workers who perform daily and terminal cleaning of all isolated patient’s room.
  6. The frequency of cleaning and disinfecting isolated patient’s room, touch-points should be increased to twice daily for best results.
  7.  At discharge or transfer, the cleaning should be a 2-step process. The first step is to clean all surfaces with a general-purpose cleaner. Concentrate on both high-touch and high-soilage areas (the toilet, the walls around the toilet where bedpan dumping may have soiled). This should provide for optimal soil removal and with the soil will go the “bad guys”. After the first step is complete, it should be followed by disinfecting all the same surfaces using the disinfectant of choice.
  8. The ES Terminal Cleaning Team (or Worker), should work from a check list of cleaning/disinfecting steps to be performed in order for the process to be completed according to policy.  This check list is signed off by the ES worker and kept with the department’s records.
  9. In order to monitor the effectiveness of the 2-step process, the management staff of ES along with IP should monitor terminally cleaned C. diff isolation rooms with the use of a hand held meter that test surfaces for adenosine triphosphate (ATP), which is the energy molecule inside all living cells. ATP is found in bacteria (i.e., C. diff), mold, fungus and other organic matter . ATP meters enable cleaning professionals to verify how clean surfaces are with respect to organic matter and to carry out continuous improvement programs to enhance overall performance.  Test results should be maintained in the ES department files for future reference.
  10.  Provide a disposable wipe with a C. diff kill claim for all healthcare workers to perform meticulous cleaning/disinfecting patient care items before removing them from the room (i.e., IV poles, stretchers, wheelchairs, etc.). Isolated patient’s room should have disposable stethoscopes that remain in the room and are discarded at discharge.
  11. Use high-denier microfiber wipers and mops. The better the microfiber product, the better the spore removal (catches spores but does not release them onto other surfaces). Infection prevention textiles (i.e., microfiber) used by ES should be washed according to published CDC guidelines (hot wash + bleach + high temp dry); people are dying from hospital associated C. diff and ES infection prevention textiles should be processed in the same manner as patient-use textiles.
  12. Privacy curtains should be taken down while stripping the room and making it ready for cleaning.  The curtains should be bagged and sent for laundering.  If the privacy curtains are disposable, discard them with other disposables.  A fresh curtain should be installed after the room has been made ready for admitting the next patient.
  13. The hospital should educate family members and visitors to adhere to the isolation precautions and use the disposable wipes throughout their stay or visit.

I invite your comments and questions about these 13 steps in preventing the spread of this disease that claims 10’s of thousands of lives annually in the U.S.



About Darrel Hicks

J. Darrel Hicks, B.A., is the author of Wiley Publishing's "Infection Prevention For Dummies", and is nationally recognized as one of the top experts in infection control. Darrel Hicks is also the Past President of the IEHA and is an active member in AHE where he holds the designation of CHESP. View all posts by Darrel Hicks

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