About 50 percent of the population naturally carries clostridium difficile (C. diff) in their intestines, states Benjamin Tanner, president of Antimicrobial Test Laboratories, Round Rock, Texas.

“It lives in harmony with the other bacteria in your intestines and doesn’t cause problems,” he says. “The only time it makes individual’s ill is when people go on multiple or individual antibiotic therapy.”

The bacteria, C. diff, exists within the body in a vegetative state and doesn’t make people sick, unless illness, disease and antibiotic use puts them at risk, Tanner explains. At that point, C. diff mutates into its active state, forming a resistant end spore that becomes difficult, if not impossible, to eradicate from the environment.

“These spores are exceedingly difficult and challenging to disinfect,” says Tanner. “Once they enter the environment, there are only a few disinfectants and technology that can kill it. The spores tend to get everywhere. They move easily from surface to surface.”

Cleaning To Prevent C. Diff Infections

Cleaning agents can only do so much if quality-cleaning practices are not adhered to.

To that end, Jewish Hospital-Mercy Health, in Cincinnati, made a number of cleaning policy changes that proved effective in warding off C. diff infections.

First, the hospital began changing the privacy curtains when C. diff patients were discharged from the hospital, and sometimes even during the patient’s hospital stay.

Realizing that restrooms are a high source of C. diff contamination, the hospital then targeted restroom-cleaning practices. Housekeepers started cleaning C. diff patient rooms twice daily — once in the morning and once in the afternoon — and cleaning tools used in these areas are never left in the room. For instance, every C. diff room gets its own toilet brush, which is disposed of once patients are discharged.

Dedicated microfiber clothes and mops are also used in these rooms, and are changed several times during the cleaning process. Up to seven cloths may be used to clean a single C. diff patient room, says Jenny Martin, manager of quality administration at Jewish Hospital-Mercy Health.

Finally, the hospital purchased a real-time adenosine triphosphate (ATP) cleaning, validation and tracking system, which environmental service supervisors use after cleaning is completed to assess whether any bacterial residue remains. If levels remain high after cleaning, they spend time retraining housekeepers so everyone maintains the same high standard of clean.

In addition to what is being done at Jewish Hospital-Mercy Health, Darrel Hicks, director of environmental services and patient transportation at St. Luke’s Hospital in St. Louis, and author of “Infection Control For Dummies,” outlines a number of common-sense steps that can be taken to ward off the spread of C. diff.

“When a patient is bed-bound and must use the bedside commode, workers need to clean privacy curtains, the beds and more. Also, laundry shouldn’t be taken into the hallway when it’s full of C. diff spores, it needs to be bagged up inside the room before transport,” she says. “We’ve also found C. diff on employee uniforms so the staff is now required to gown up before they go into a patient room, plus hand washing protocols are further emphasized. Otherwise C. diff is being carried around the hospital on the hands and uniforms of nursing staff and doctors.”

Wash Your Hands Against C. Diff

Proper disinfection of surfaces is critical because C. diff not only lives on surfaces, but it can spread to and thrive on hands. As soon as clean hands touch contaminated surfaces they are not clean anymore.

With this in mind, Hicks stresses to environmental service providers that they advocate for proper hand washing, using soap and water.

Experts emphasize that although soap will not kill the C. diff spore, the act of washing and scrubbing hands will remove the bacteria. The same cannot be said for the use of sanitizers.

“Using hand sanitizer does nothing against C. diff,” Tanner says. “We actually sometimes store C. diff spores in ethanol — a common ingredient in sanitizers — and they are happy as a clam in a sea of ethanol.”

Because the compounds of sanitizers will not penetrate the C. diff spore, and the act of sanitizing doesn’t wash away the bacteria, experts suggest facilities remove sanitizers from affected areas. St. Luke’s Hospital does just that and covers up hand sanitizer dispensers in C. diff rooms as part of its protocol so affected patients don’t have a false sense of security.

Hospital workers have long known the importance of washing their hands as opposed to just using sanitizers, but they have taken it a step further to educate patients, caregivers and family members.

“I tell patients and their families that you need to advocate for this and insist that before someone administers any care that you see them wash their hands with soap and water,” Hicks says.

Keep C. Diff On Your Radar

Departments should revisit cleaning protocols frequently, says Martin, and continually train workers to follow them. She notes that even though the hospital saw a 50 percent decrease in the first six months after the program began, and a further drop the following year, when the hospital’s C. diff infections nudged up slightly in 2012, they reconvened the C. diff task force to figure out why.

“One time we found out the slight uptick was due to environmental services staffing changes, so we had to put our practices back into place immediately,” says Martin. “Another time we found nurses had started bringing their phones into the Intensive Care Unit again and they had to stop that practice. It just goes to show that it doesn’t take much to get you in trouble again. We have this on multiple agendas at all times to keep people on top of what’s going on.”

Cleaning crews can do much to keep C. diff infections at bay, but only if they keep it on their radar and constantly assess and improve their practices. It’s important — for ill patients, it can be a matter of life and death.  

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

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