CHICAGO – Nearly one-third of patients diagnosed with Clostridium difficile infection in the previous 2 months had positive rectal cultures during follow-up visits to outpatient clinics.
Acquisition of C. difficile spores on gloved hands occurred often, especially after contact with skin sites, Lucy A. Jury reported during a poster session at the annual Interscience Conference on Antimicrobial Agents and Chemotherapy.
Lucy A. Jury
"Charts of patients who have a C. difficile infection in the past 2 months should be flagged before they come to the outpatient clinic," Ms. Jury, a nurse practitioner with the Geriatric Research Education and Clinical Center at the Cleveland Veterans Affairs Medical Center, advised in an interview. "After they leave the exam room, that room should be bleached out and providers should wash their hands between seeing patients. Clean where the patient was sitting, and any surfaces the patient came into contact with."
She and her associates performed a 4-month prospective study of 35 C. difficile patients diagnosed in the prior 2 months and subsequently seen in outpatient clinics affiliated with the Cleveland VA Medical Center. The researchers obtained rectal swab cultures from all patients, as well as gloved hand print cultures after contacting the patients’ skin (abdomen, chest, arm, and hand) and environmental sites (exam room chair, exam table, and physician work area).
The mean age of the 35 patients was 66 years, 33 (94%) were male, and 7 (20%) resided in long term care facilities. Ms. Jury reported that 7 of the patients (20%) were still on C. difficile therapy, 3 (9%) had diarrhea, and 11 (31%) had positive rectal cultures.
Acquisition of spores on gloved hands occurred often, particularly after contact with any skin site (45%), followed by the hand (23%), chest (20%), abdomen (16%), and arm (14%). Spores were also detected on environmental sites (20%), especially the examination table (19%) and the chair used by patients in the examination room (5%).
For positive glove print cultures, Ms. Jury said that the mean numbers of colonies acquired after contact with skin and environmental sites were 18 and 5, respectively.
The conference was sponsored by the American Society for Microbiology. Ms. Jury said that she had no disclosures.