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Expert panel releases prevention recommendations for nosocomial C. difficile
A set of recommendations established by a panel of infectious diseases specialists on the prevention of nosocomial Clostridium difficile infection have been published by researchers in Clinical Infectious Diseases.
Led by Infectious Disease News Editorial Board member Ellie J. C. Goldstein, MD, of R.M. Alden Research Laboratory and the David Geffen School of Medicine at the University of California, Los Angeles, the eight experts developed the guidelines using a modified Delphi process. Following a literature review, researchers proposed potential C. difficile-associated diarrhea (CDAD) prevention measures and risk factors for the panel to review. After providing clinical opinions, evaluating the strength of published evidence and modifying recommendations, the panel voted on the statements to create a final set of C. difficile recommendations.
Of the 17 recommendations presented, the panel voted to approve 11. These included:
- initiating antibiotic stewardship;
- reducing the use of proton pump inhibitors;
- consuming Lactobacillus acidophilus CL1285 and L. casei LBC80R probiotics;
- educating staff on CDAD preventive measures;
- practicing appropriate hand hygiene among all health care providers;
- regularly cleaning rooms vacated by patients with CDAD with sporicidal agents;
- regularly cleaning medical equipment using sporicidal agents;
- implementing diagnostics for the early detection of CDAD in symptomatic patients;
- using protective gloves and clothing when working with CDAD patients;
- adhering to preventive measures during outbreak; and
- using surveillance data to monitor and implement CDAD preventive measures.
Due to a lack of conclusive or acceptable data, the panel did not accept recommendations against the use of statins, opioid analgesics, corticosteroids, chemotherapy, hyponutrition, catheters and tube feeding.
Ellie J.C. Goldstein
“Over the last decade, C. difficile has imposed an increasingly heavy burden on the health care system, especially when it occurs in hospitals,” the researchers wrote. “A key objective should be the reduction of CDAD incidents, and, to this end, numerous scientific reviews have evaluated potential preventive measures. In this paper, fresh insight has been added with the inclusion of the expert panel’s evaluation of the relative importance of the multiple preventive measures discussed.”
Disclosure: All authors report membership within the Bio-K Plus Scientific Advisory Board, but own no stock or equity in the company.