Role of the hospital environment in disease transmission, with a focus on Clostridium difficile

Contamination of the surface environment in hospital rooms plays an important role in the transmission of several key healthcare-associated pathogens including Clostridium difficile, methicillin-resistant Staphylococcus aureus (MRSA), vancomycin-resistant Enterococcus spp. (VRE), Acinetobacter spp. and norovirus. Clostridium difficile is especially important as it is now the most common healthcare-associated pathogen in the United States. It may cause serious disease, especially in older individuals, it may survive for long periods of time in the environment and it is relatively resistant to many commonly used antiseptics and disinfectants.

Evidence that the contaminated surface environment is important in the transmission of C. difficile includes the following: (1) environmental contamination is frequent in the rooms of patients with C. difficile infection (CDI), (2) the hands/gloves of healthcare personnel are as likely to become contaminated from contact with the environment as from direct contact with the patient, (3) the higher the frequency of environmental contamination, the more frequent the contamination of the hands/gloves of healthcare providers, (4) patients admitted to a room previously occupied by a patient with CDI have an increased risk of developing C. difficile infection, and (5) improved cleaning/disinfection of the environment has led to a decrease in the incidence of C. difficile transmission.

Key measures to prevent C. difficile transmission and infection include antibiotic stewardship (minimising antibiotic use), placing patients with CDI on contact precautions, and proper cleaning and disinfection of the surfaces in hospital rooms daily and at discharge using a sporicidal disinfectant or a ‘no-touch’ method (e.g. ultraviolet light).