In 2009, officials at Jewish Hospital-Mercy Health knew they had a problem — its Clostridium difficile (C. diff) incidence rate had hit an all-time high of 25.27 per 10,000 patients and they didn’t know why.

“We had to do something to prevent the spread of C. diff,” says Jenny Martin, manager of quality administration.

The Cincinnati hospital convened a task force of clinical services professionals, physicians, nurses, administrators and environmental service workers to assess the spike in infections caused by this deadly bacterium, which ravages the intestines. They found that the patient makeup of the 209-bed hospital was partly to blame. C. diff is a bacterium that preys on the sick, particularly those who are elderly or immunocompromised — of which Jewish Hospital-Mercy Health had plenty of both.

“We have an older patient population — the average patient age is 72 years old — and we have a blood and bone marrow transplant center,” Martin says. “The type of antibiotics we use makes these patient populations very susceptible to C. diff infections.”

Hospital officials acted quickly and were able to slash the facility’s high C. diff rate by 50 percent in six months by standardizing care, adopting stricter antibiotic controls and incorporating new room-cleaning protocols.

“But in all honesty, the changes to our environmental cleaning practices had the most significant impact out of all of the changes we made,” says Martin.

As this example shows, when it comes to C. diff and similar hospital-acquired infections, custodial cleaning practices can make a world of difference.

Chemicals Combat C. Diff

While antibiotics cannot always treat C. diff infections, good cleaning and hygiene can prevent it from spreading. It’s safe to say when it comes to C. diff the best offense is a good defense.

Cleaning with bleach is the No. 1 means of attacking C. diff spores, say experts.

“There are probably only four to five EPA-registered bleach-based disinfectants with a C. diff claim. These have passed laboratory testing showing they can kill millions of C. diff spores on a surface,” says Benjamin Tanner, president of Antimicrobial Test Laboratories, Round Rock, Texas. “They are currently the best way to clean C. diff from a surface.”

Darrel Hicks, director of environmental services and patient transportation at St. Luke’s Hospital in St. Louis, and author of “Infection Control For Dummies,” agrees that the best disinfectants used in a C. diff situation are bleach based.

“The C. diff spore is very difficult to break through and conventional disinfectants won’t do it. You have to use a sporicidal disinfectant,” he says. “Though bleach can be highly corrosive to surfaces, it is effective against C. diff and our goal is to help save people’s lives.”

As an alternative to bleach, some facilities are experiencing success in the fight against C. diff by using accelerated hydrogen peroxide (AHP) products. These are clear, colorless and odorless products that are less harsh than bleach counterparts.

Composed of hydrogen peroxide, surface acting agents (surfactants), wetting agents (allows liquid to spread easier) and chelating agents (helps to reduce metal content and/or hardness of water), AHPs have proved successful in killing C. diff spores. In fact, according to testing done by American Journal of Infection Control, when used as directed, AHP proves to be as effective as bleach.

No matter which disinfectant is used to prevent C. diff, Tanner advises paying critical attention to dwell times in patient rooms.
“There’s a linear relationship between how long a disinfectant remains wet on a surface and how much disinfection you get,” he says. “You can take a great disinfectant, such as bleach, and if you only leave it on a surface for five seconds, you won’t get nearly the effect you need. Contact time is critical for liquid disinfectant. If you don’t use it long enough, you won’t get the same level of disinfection.”

At St. Luke’s Hospital, Hick’s staff cleans C. diff patient rooms twice daily. Housekeepers perform thorough cleaning once a day, and then come back a second time to cleanse all high-touch surfaces in the room.

“We go over these surfaces with bleach wipes,” Hicks says. “We go after the spores on a daily basis rather than just on discharge like a lot of hospitals do.”

Technologies That Prevent C. Diff

Although chemicals are used most often to prevent C. diff, they aren’t the only option. Tanner maintains that new technologies are emerging to give departments alternative choices. For example, technologies such as ultra-violet (UV) light systems, room foggers and industrial steam cleaners have emerged.

UV room disinfection systems flood a room with UV light via a flashing bulb or solid light. These devices offer an advantage over traditional cleaning methods, says Tanner, because they hit every single surface in a hospital room.

“Studies have shown that out of all the surfaces that must be cleaned in a hospital room, only 39 percent will actually be cleaned by housekeepers,” he says. “A UV system hits every single high-touch surface, every time it’s used.”

In addition, two- or three-log reductions (a mathematical term used to show the relative number of live microbes eliminated from a surface by disinfecting or cleaning) can be possible with these systems. In other words, germ counts could be 10 to 1,000 times smaller by using this technology.

“I think over time you’ll see UV light systems become ‘the’ solution to the C. diff problem,” Tanner says, noting their lack of popularity probably has more to do with the cost of these systems and the general lack of acceptance among infection control professionals who still see bleach as the only effective means of attacking C. diff.

Room foggers present another option. These systems pump hydrogen gas into a room to kill C. diff end spores. While these units effectively kill bacteria, they can take two to three hours to do so. And because the gas they push into the room is highly toxic, it requires the room to be sealed off while fogging takes place.

Steam cleaners are another tool that may be effective against C. diff. Though C. diff spores are naturally heat-resistant, Tanner says he’s seen at least two studies from separate labs that have shown steam cleaning can reduce the amount of C. diff spores by up to 90 percent.

“Steam cleaning is likely most appropriate for high-touch surfaces such as bed rails, doorknobs and things like that,” he says.

RONNIE GARRETT is a freelance writer based in Fort Atkinson, Wis.

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Practices That Ward Off C. Diff Infections