moved to another room to avoid reinfection. Mandatory gloving and gowns before entering
the room should be initiated. SinceC. difficilespores can survive for long periods of time on
environmental surfaces, it is important to prevent spread to clothing and to use designated
portable equipment for patients on precautions. Compliance with hand hygiene should be
emphasized. Alcohol-based hand washing agents appear less able than soap and running
water to remove spores from the hands. However, no increase in CDI rates has been shown in
hospitals using alcohol-based hand washing agents. During the setting of an outbreak, visitors
and HCWs should wash their hands with soap and water after caring for patients with CDI.
HCWs or asymptomatic patients should not be screened for fecal carriage during CDI
outbreaks (45).
Particular emphasis must be given environmental cleaning and disinfection due to the
C. difficilespores ability to survive on fomites for prolonged periods of time and are only
destroyed by high heat or alkaline pH (45). Only chlorine-based disinfectants and high
concentrations of vaporized hydrogen peroxide have been shown to be sporicidal (45,64).
Generic bleach (containing at least 1000 ppm available chlorine) should be used to address
environmental contamination. Horizontal (high touch) surfaces and fomites that commonly
harborC. difficilespores (e.g., bed rails, telephones, call buttons) should be thoroughly cleaned
and decontaminated. Routine environmental screening forC. difficileis not recommended.
Restrictions in the use of antimicrobials are also important in CDI prevention and
control. Antimicrobial stewardship programs can help minimize antimicrobial duration and
number of agents prescribed to reduce CDI risk. Hospital-wide restrictions of implicated
antibiotics (such as clindamycin and cephalosporins) have been shown to effectively reduce
the incidence of CDI cases as well as decrease resistance to the implicated antibiotic (45,64).
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