Clostridioides difficile (CD) infection is a major cause of infectious diarrhea among
Bone Marrow Transplant (BMT) patients. Previous research showed asymptomatic colonized
patients with CD may confer a risk for nosocomial transmission. We found that 14%
of patients admitted to our BMT unit were colonized with toxigenic CD. The objective
of this study is to determine patient room contamination by asymptomatic patients
colonized with CD.
The BMT unit implemented CD colonization screening upon admission using polymerase
chain reaction (PCR) CD testing on formed stools. Screening was performed on patients
undergoing BMT, experiencing complications, or patients with a hematology diagnosis.
PCR CD testing was performed on the first formed stool.
Three surfaces: toilet, bathroom sink, and in-room computer keyboard were sampled
by swabbing the surface with a sponge moistened with buffer. The sponge was mechanically
stomached to release recovered microorganisms. Samples were dilution plated onto agar
plates and incubated anaerobically at 37°C for two days. Sample cutoffs are reported
as < 10 colony forming units (CFUs) as the lower limit of detection. Samples with
< 10 CFUs are considered negative.
Six hundred ninety eight patients had specimens submitted for screening. One hundred
one (14%) patients screened positive for CD toxin. Of the 101 patients who screened
positive, thirty eight rooms were cultured. Seventeen of the rooms were negative at
all sites for CD spores, while 6 rooms were positive at all sites. The remaining fifteen
rooms had a least one site positive. Seventeen toilet seats were positive for CD spores,
followed by 14 keyboards and 8 bathroom sinks.
Room contamination from asymptomatic BMT patients colonized with CD does occur. Further
analysis of the data may delineate the environmental risk from asymptomatic colonized
patients. These findings may have implications for infection control measures needed
to mitigate the risk of healthcare-associated CD infection.
Co-Author: Zeinab I. El Boghdadly, MBBCh – Infectious Disease, The Ohio State University Wexner Medical Center
Co-Author: Misty Lamprecht, MS, APRN-CNS, AOCN, BMTCN – Clinical Nurse Specialist, The James Cancer Hospital and Solove Research Institute The Ohio State Wexner Medical Center
Co-Author: Samantha M. Jaglowski, MD, MPH – Hematologist, The James Cancer Hospital and Solove Research Institute, The Ohio State University Wexner Medical Center
Co-Author: Lisa Hines, MACPR, BS, RN, CIC, FAPIC – Infection Preventionist, Wilcox Health - Hawai'i Pacific Health
Primary Author: Christina Liscynesky, MD – Infectious Disease, The Ohio State Wexner Medical Center
© 2020 Published by Elsevier Inc.