Room Contamination by Patients Colonized with Clostridiodes Difficile

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      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.
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