Category Archives: EPA Registered C. diff kill cleaning products: Environmental Safety

U.S. Environmental Protection Agency (EPA) Announced Methods and Guidance for Evaluating Efficacy of Antimicrobial Products against Clostridium difficile Spores


On September 29, 2017, the U.S. Environmental Protection Agency (EPA) announced the availability of two final test method Standard Operating Procedures (SOP) for evaluating the efficacy of antimicrobial products against  Clostridium difficile (C. diff) spores.

EPA also released regulatory guidance for test criteria and pesticide claims for these products, specifically “Methods and Guidance for Testing the Efficacy of Antimicrobial Products Against Spores of Clostridium difficile on Hard Non-Porous Surfaces.”  These test methods and guidance provide a framework for registrants who seek to make a claim for antimicrobial pesticide products to control these spores on hard, non-porous surfaces.

C. diff is an anaerobic, spore-forming bacterium and a  leading hospital-acquired infection.  The spores survive on hard surfaces such as glass, metals, and plastics that are commonly found in health-care settings.

Antimicrobial pesticides are used to reduce the number of spores on environmental surfaces.  Under the Federal Insecticide, Fungicide, and Rodenticide Act (FIFRA), the registrant of an antimicrobial product with a public health claim is required to submit efficacy data to EPA in support of the product’s registration.

EPA MLB SOP MB-28 describes the test methodology for producing and storing standardized spore suspensions of C. diff based on ASTM E2839, Standard Test Method for Production of C. difficile Spores for Use in Efficacy Evaluation of Antimicrobial Agents (ASTM International).  A spore suspension should be developed and qualified according to EPA MLB SOP MB-28 before an efficacy evaluation can be performed using method EPA MLB SOP MB-31.  EPA MLB SOP MB-31 describes a quantitative method intended for evaluating the sporicidal efficacy of liquid disinfectants against spores of C. diff on inanimate, hard, non-porous surfaces.

EPA solicited comments on the clarity of the test method SOPs and the regulatory guidance in December 2016.  EPA received comments from twelve entities and revised the drafts to incorporate suggested changes.  EPA posted its response to those comments in Docket No. EPA-HQ-OPP-2016-0753-0026.  EPA also is working with ASTM International, a standard-setting organization, on adoption of these test methods as official ASTM standards.

EPA’s response to comments and other documents associated with this action are available in Docket No. EPA-HQ-OPP-2016-0753 at

The methods and guidance also are found on EPA’s Antimicrobial Testing Methods & Procedures Developed by EPA’s Microbiology Laboratory webpage, at the Methods tab as Method IDs MB-28 and MB-31, and at the Guidance tab as Sporicidal Claims Against Clostridium difficile.



4 Year Sepsis Study of New York’s Sepsis Regulations Being Launched By University of Pittsburgh Researcher

A University of Pittsburgh researcher is launching a four-year study of New York’s sepsis regulations to see what worked and what didn’t in the state’s fight against one of health care’s biggest killers.

Research has shown that speeding up sepsis treatment, which New York’s law accomplished, reduces deaths from the condition . The new study will examine the law more broadly, probing whether it might have had unintended negative consequences.

“Just because the protocol is good doesn’t mean that a regulatory-based effort to force hospitals to adopt these protocols led to better outcomes,” said Dr. Jeremy Kahn, a Pitt professor of critical care medicine and health policy and management who is heading the $1.5 million study.

New York required hospitals to adopt time-based sepsis protocols in 2013 after a 12-year-old boy, Rory Staunton, died from the condition after cutting his arm in a gym class a year earlier. The condition, in which the body’s immune system overreacts to infection, contributes to as many as half of all hospital deaths, according to the National Institutes of Health.

Sepsis has been likened to heart attacks and strokes, which killed many more patients before evidence-based treatment protocols were adopted. Hospitals in most states aren’t required to do anything specific to treat the condition, although many have voluntarily adopted protocols. Pennsylvania Health Department officials have said they plan to launch a two-year process this fall to incorporate sepsis protocols in the state’s hospital regulations.

New York’s protocols include taking blood cultures to guide diagnosis and treatment, analyzing lactate levels that can signify septic shock and administering fluids and antibiotics.

Kahn said the protocols raise concerns over two primary dangers: overuse of antibiotics and overuse of fluids.

The study of New York’s three-hour protocols found that administering fluids didn’t appear to improve outcomes, and too much fluid can lead to harm, Kahn said. Antibiotics, while a critical part of sepsis treatment, can also harm patients by killing good bacteria in the gut and creating a more welcoming environment for a deadly infection known as C-diff.

The new study, funded by the federal Agency for Healthcare Research and Quality, will examine complications, length of hospital stays, costs and other elements of the protocols, Kahn said. The study will compare sepsis treatment outcomes in New York to outcomes in Pennsylvania, Massachusetts, Washington and Florida, he said — states with similar numbers and types of hospitals.

“The hope would be to help policymakers in other states, specifically in Pennsylvania, as they design these regulations,” he said.

He expects bigger hospitals with more resources will have better sepsis outcomes than smaller rural hospitals. Another factor that might influence outcomes is whether hospitals have a designated sepsis specialist who influences how hospitals approach the condition.

Researchers plan to study the effects of sepsis policies for the first two years — delivering early results to Harrisburg before the planned update to hospital regulations — and to spend another two years interviewing doctors and health care specialists to gather more detail about how the protocols work.

“We can’t stand by as hundreds of thousands of Americans are dying each year of sepsis,” Kahn said. “But the question is, can we craft those policies; can the policy response to sepsis be evidence-based?”

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Join us in our dedicated fight against C. diff. and help us continue our mission of educating, and advocating for C. difficile infection prevention, treatments, and environmental safety and saving lives worldwide



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Xenex Disinfection Services’ LightStrike™ Robot With Pulsed Xenon Ultraviolet-C (UV-C) Light Technology Introduces Its LightStrike Disinfection Pod

The scientific evidence has clearly established that in the hospital environment, microorganisms such as Clostridium difficile (C.diff), Methicillin-resistant Staphylococcus aureus (MRSA) and carbapenem-resistant Enterobacteriaceae (CRE) are responsible for the infections that kill nearly 300
people in the U.S. every day.

Xenex Disinfection Services’ LightStrike™ Robot with pulsed xenon ultraviolet-C (UV-C) light technology is a proven solution that quickly destroys deadly viruses, bacteria and spores before they pose a threat to patients and healthcare workers. LightStrike Robots help healthcare facilities reduce their HAI rates by destroying the microscopic germs that may be missed during the manual cleaning process. Xenex robots use pulsed xenon, a noble gas, to create Full Spectrum™, high intensity UV light that quickly destroys infectious germs in less than five minutes. Hospitals using Xenex devices have published clinical outcome studies in peer-reviewed journals showing 50-100 percent reductions in C.diff, MRSA and Surgical Site Infection rates when those hospitals used LightStrike Robots to disinfect rooms.

Ingenia MR-OR intraoperative MRI delivers high-quality images during neurosurgical procedures. It helps you gain up-to-date insight on surgical procedures & tumor resection & supports smooth, in-line patient transfer between the OR and Philips Ingenia MR

Now, for the first time, hospitals can utilize the power of

LightStrike Germ-Zapping Robots™ to quickly disinfect mobile equipment just as effectively as they disinfect rooms within their facility. Pathogens like C.diff, Acinetobacter baumannii, MRSA and Vancomycin-Resistant Enterococci (VRE) can travel throughout a healthcare facility on mobile equipment.

To address this gap in the infection control process, Xenex recently partnered with an industry leader in containment units, Mintie Technologies, Inc., to create the LightStrike Disinfection Pod.

Designed to quickly disinfect reusable mobile equipment such as isolettes, ventilators, pressure monitors, wheelchairs and workstations, the

LightStrike Disinfection Pod enables the power of the LightStrike Robot’s intense, germicidal light to be used anywhere in a facility.
The Pod is collapsible, mobile and can be positioned in a hospital hallway or other areas without disrupting or impeding daily workflow. Its proprietary design integrates reflective interior fabric ensuring 360 degrees of UV light coverage over difficult-to-clean equipment including anesthesia carts, ventilators, and mobile imaging machines.

To access and read the article in its entirety please click on the link below:

June 2017 Newsletter



5th Annual International C. diff. Awareness

Conference & Health EXPO Updates

Welcome to the 5th Annual International C.diff. Awareness Conference & Health EXPO  second update.  The Conference & Health EXPO begins on November 9th at 8:00 a.m. and concludes on November 10th at 3:00 p.m. There are over twenty guest speakers, leading topic experts, sharing up-to-date data with an audience of health care professionals from a variety of management levels and specialties, medical educators, medical students, and professionals with shared interests. The venue is the University of Nevada Las Vegas (UNLV) Thomas and Mack Center in conjunction with the Embassy Suites Convention Center where staff and event coordinators are working together to create this amazing event.  Embassy Suite Convention Center hotel accommodations are now at a “limited availability.”  Please utilize the hotel reservation portal available on the conference page
We are truly grateful for the following Corporations and Sponsors of this educational conference, also exhibiting.
An educational grant has been awarded to the C Diff Foundation by
Sanofi Pasteur USA.  It is through their continued support that this event is made possible:
Synthetic Biologics
Clorox Healthcare
Nestle Health Science
Seres Therapeutics
EDM – Environmental Disinfection Management
Contagion Live
Just Ask Where Concierge
Safety Net
Live Broadcasts on Tuesdays at:   
10a PT,    11a MT,   12p CT,    1p ET 
June 6th :   Global Sepsis Alliance
June 13th:   Kristopher Maday, PA
June 20th:   Home Care and C. diff.
June 27th:   Advocating In Healthcare

Baking For C.diff. Awareness

Volunteer Patient Advocates, with the
C Diff Foundation Members,  were busy in the kitchens baking across the globe to support our mission and provide education at each event.
We kicked off the month long chain of events with a successful recipe to educate and advocate for
C. difficile infection awareness worldwide.  More than 700 brochures were shared at the bake sales meeting  the goal –  promoting C. diff. infection prevention, treatments, environmental safety and support across the globe during the month long campaign.  Thank You to everyone involved making this campaign a global success.

Save the Date

On September 14th a day to  Honor the Professionals Dedicated to Clostridium difficile Research and Development. Their Efforts Bring Forth New Concepts, New Theories, and the Progress Towards A Better Understanding – Pursuing Future Developments In Clostridium difficile           (a.k.a., C.diffiicle, C.diff.).
September 14th,   8:00 a.m. – 12:00 p.,m. ET
This free, live webinar by C.diff. Science, is to honor Professionals in the Science community, leading the way advancing C. difficile Infection Prevention, Treatments, and Environmental Safety Products worldwide  –  hosted by the C Diff Foundation –  a slate of industry leaders and medical researchers — from highly regarded health systems — share their journeys and efforts focused on Clostridium difficile research and development that will be appreciated by colleagues, fellow-researchers, and the scientific teams within organizations.
Visit To View the Guest Speakers, Presentation Topics.
Register For This One Day Educational Event and Don’t Forget To Share the News.
June  9     Scott Battles: C. diff. Q & A
June 15    Karen Factor,RD, Nutrition
June 19    Lisa Hurka-Covington, Anxiety
June 20    Roy Poole, CO  C. diff. Q & A
June 26    Dr.Oneto,MD  and
                 C. diff. – The What,Where,How.
                   Sign up today
Where Support Is Just a Phone Call Away ♥ 

Support and information sessions are for everyone especially for —

  • Patients and their Families.
  • Clinicians,
  • C. diff. survivors continuing their recovery from a prolonged illness.
  • Patients working their way through any long-term wellness draining diagnosis.
Sessions are accessible from the USA and
57 Countries

Connect with others being treated for and recovering from a C.diff. Infection.

Ask questions, get advice & support.
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Treasure Island, FL Community EXPO Promoting

 C.diff. Awareness

It was a pleasure joining the local residents of Treasure Island, Florida on May 18th.  Educating and Advocating for C. difficile infection prevention, treatments, and environmental safety, a shared goal to witness a decline in newly diagnosed
C. diff. cases worldwide.  To view upcoming events of interest, please visit
“None of us can do this alone, all of us can do this together.” 
C Diff Foundation
6931 ian Ct  #14
New Port Richey, FL 34653
(919) 201-1512
See what’s happening on our social sites:
C Diff Foundation | 6931 Ian Ct #14, New Port Richey, FL 34653

An Article Written By A Pharmacist: There Are Ways Pharmacists Can Have a Positive Impact On Patient Care When It Comes To A Clostridium difficile Infection (CDI)

There are a myriad ways pharmacists can have a positive impact on patient care and show their value within healthcare institutions when it comes to CDI.




To read the article in its entirety please click on the following link:

First, pharmacists should lead by example on patient care rounds by always wearing personal protective equipment (including gloves) when entering a room and washing their hands after leaving a room. You know how hand sanitizers claim to kill 99% of germs?

With CDI, welcome to the 1%. It takes good old-fashioned soap and water to remove CDI spores for your skin and prevent you from passing the pathogen to a colleague or patient.

That’s the crazy (or is it sad?) thing about CDI – we cause it with antibiotics, and we spread it amongst each other.

It is important for infection control specialists and antimicrobial stewardship (AMS) teams to work together to decrease CDI rates.

Pharmacists are pivotal members of AMS teams, but even those without a formal role in AMS can (and should) consider all medication-related problems surrounding CDI.

They can recommend appropriate treatment for CDI, leverage their knowledge of medications to help prevent CDI primary infection and recurrence, and think beyond CDI in patients presenting with diarrhea by considering non-medication and medication-related causes.

This peer-reviewed blog post only highlights five of the many interventions pharmacists can make to improve patient care. There is an abundance of other issues surrounding CDI that are not addressed below.

Notably, the role of probiotics for primary and secondary prevention and the role of fidaxomicin and/or fecal transplantation in a CDI treatment algorithm will be saved for another day.

This post also does not address the new FDA-approved monoclonal antibody, bezlotoxumab, which works by binding and neutralizing CDI toxin B. This novel medication demonstrated promising results in phase 3 trials and was associated with a significantly lower CDI recurrence rate than placebo. However, this drug cashes in around $5,000 per dose for a 70 kg patient (without a non-industry sponsored cost-effectiveness analysis in sight). The role in therapy for bezlotoxumab will be an exciting conversation in the ID community this year, so stay tuned!

In the meantime, here are five medication-related interventions that are easy to learn and easy to implement in order for pharmacists to make a huge difference for patients with CDI.

1. When in doubt, don’t pick metronidazole

I recently attended a conference where a speaker presenting on CDI asked the audience this question: “Would you give your mom metronidazole?” This resonated with me as I realized the answer was… probably not.

The 2010 Infectious Diseases Society of America (IDSA) guidelines for CDI in adults recommend the use of metronidazole for mild-to-moderate disease and oral vancomycin for severe disease.

Patients should be treated for 10-14 days regardless of disease severity [3]. For patients who experience a first recurrence, it is recommended to treat based on severity of illness, regardless of the previous therapy the patient received. If a patient experiences a second CDI recurrence, the guidelines recommend avoiding metronidazole not for efficacy concerns, but for drug toxicity and safety concerns associated with prolonged use.

The problem with these recommendations is that CDI severity varies widely and there is no universally accepted determinant of “severe” disease. Additionally, enhanced data on phenotypic and genotypic resistance mechanisms in C. difficile noting reduced susceptibility to metronidazole and pharmacokinetic data explaining the poor fecal concentrations of metronidazole leave us questioning if there is any patient population for whom metronidazole is appropriate empiric therapy.

Historically, the decision to use metronidazole over vancomycin has been driven by cost (metronidazole is much cheaper than oral vancomycin). There is also concern that use of oral vancomycin will drive emergence of vancomycin-resistant enterococci and other multidrug-resistant organisms by causing greater disruption of the intestinal microbiota, which appears to be the case in murine models but has not been demonstrated in humans [4,5].

As enhanced diagnostic testing is developed (including polymerase chain reaction [PCR] ribotyping for detection of the hypervirulent NAP1/BI/027 strain of Clostridium difficile), it should be easier to determine patients with severe or hypervirulent disease. In the absence of this testing, however, clinical presentation and laboratory parameters including white blood cell count > 15 x 103/mm3, albumin < 2.5 g/dL, and/or serum creatinine ≥1.5 times baseline drive decisions regarding disease severity.

A recent Veterans Affairs (VA) study of more than 10,000 patients with CDI found that patients who received oral vancomycin had a lower risk of mortality across all severities of illness [6]. The authors note this difference was largely driven by patients with severe disease, where patients were approximately 20% less likely to die of any cause within 30 days if they were treated with vancomycin over metronidazole. There were no differences in mortality found in patients with mild-to-moderate disease or in CDI recurrence between treatment options irrespective of disease severity. These findings corroborate previous studies, which demonstrated superiority of vancomycin for clinical cure in severe disease. While not statistically significant, a numerically greater percentage of patients achieved clinical success with vancomycin and a lower percentage of patients experienced disease recurrence versus those treated with metronidazole, regardless of disease severity [7,8].

In the aforementioned VA study conducted by Stevens and colleagues, 42% of patients presented with severe disease, yet only 4% to 6% received initial vancomycin therapy [6]. Hopefully, antimicrobial susceptibility testing and ribotyping will become more widely available to help clinicians tailor CDI therapy to the infective strain. Until then, pharmacists can ensure that patients with severe disease or disease recurrence (regardless of severity at the time of recurrence) receive oral vancomycin therapy to enhance the likelihood of clinical success and to attenuate the chance of additional recurrence. It may be reasonable to start patients with mild-to-moderate disease and experiencing their first CDI on metronidazole, but they should be monitored closely and switched to oral vancomycin if they do not have adequate response to therapy.

2. Forget about fluoroquinolones

It is no secret that the number one risk factor for developing CDI is antibiotic exposure, but not all antibiotics were created equally when it comes to this risk. Fluoroquinolones have the highest odds ratio of CDI (2-12.7), trumping cephalosporins (1.6-5.4), clindamycin (1.8-4.8) and beta lactam/beta-lactamase inhibitor combinations (1.9); although recent literature suggests that carbapenems and clindamycin are associated with more CDIs than penicillins, carbapenems, and fluoroquinolones [9,10].

Fluoroquinolone-resistant strains of Clostridium difficile are correlated with the rising prevalence and spread of the hypervirulent NAP1/BI/027 strain. A recent study conducted in England found that national infection control efforts and antimicrobial restriction led to a significant decline in incidence of CDI [11]. While clindamycin, broad-spectrum cephalosporins, and fluoroquinolones all had restrictions during the study period, the authors attribute moving the needle on CDI rates to fluoroquinolones based on genome sequencing and fluoroquinolone susceptibility patterns. Commentary on this study points out the retrospective, quasi-experimental study design and states results should be interpreted cautiously. As mentioned above in regard to choosing appropriate empiric therapy for CDI, the author writes how molecular typing and susceptibility testing are crucial for providers to truly understand CDI and enable us to implement antimicrobial stewardship interventions that will make an impact.

When you combine the CDI data with recent FDA warnings about fluoroquinolone safety and the impact fluoroquinolone overuse has on organism nonsusceptibility (also known as antibiotic “collateral damage”), it is reasonable to avoid fluoroquinolones whenever possible when selecting antibiotic therapy. My institution piloted a fluoroquinolone restriction in our MICU, SICU and abdominal solid organ transplant units last summer and expanded this initiative housewide last month. It can be done!

Suggested additional reading:

  1. Sarma JB, Marshall B, Cleeve V, Tate D, Oswald T, Woolfrey S. Effects of fluoroquinolone restriction (from 2007-2012) on Clostridium difficile infections: interrupted time-series analysis. J Hosp Infect. 2015;91:74-80.
  2. Kallen AJ, Thompson A, Ristaino P, et al. Complete restriction of fluoroquinolone use to control an outbreak of Clostridium difficile infection at a community hospital. Infect Control Hosp Epidemiol. 2009;30:264-72.

3. Less is more (and antimicrobial stewardship is the best)

First, as good antibiotic stewards we should ensure patients receive antibiotics only when they have a true infection (we won’t even talk about asymptomatic bacteriuria). After the patient is deemed clinically infected, it is our responsibility to ensure the right drug is administered at the right dosage for the right duration. Limiting days of therapy to the shortest appropriate duration is crucial to limiting antibiotic exposure and improving patient outcomes. Cumulative antibiotic exposure is particularly hazardous for CDI risk, and this risk can persist for up to 6 months after exposure to any antibiotic [12]! Have I mentioned yet how important antimicrobial stewardship is?

For example, consider a patient with a pneumonia diagnosis. It is a fairly common occurrence for patients to receive approximately 72 hours of vancomycin and piperacillin-tazobactam empiric therapy, and then be prescribed an additional 7-10 days of definitive therapy. Healthcare teams forget that the days of vancomycin and piperacillin-tazobactam count and with clinical improvement most patients should not require more than 7 days of total antibiotic therapy for this infection. Defining day 1 of therapy will vary based on the patient’s clinical status, culture data, and source control. Having the conversation early and often with providers, though, can help the entire team come to an agreement on day 1 and think about defining duration. Pro tip: If you are working on a Thursday or Friday and an antibiotic course is near anticipated completion, ask for those stop dates early to avoid the antibiotics carrying through the weekend. Those extra couple of days or doses do make a difference!

The world would be simpler if this were just an inpatient issue. Community-acquired CDI is just as serious as hospital-acquired CDI, and prevalence in the community is rising. Pharmacists can review discharge prescriptions from inpatient settings or the emergency department at the point of discharge, or once the patient arrives at a community pharmacy. If the duration or quantity seems excessive, it probably is. Do not hesitate to contact providers and ask for clarification on treatment duration to help limit antibiotic exposure and decrease the risk of CDI!

4. Ask why when it comes to the PPI

Antibiotic use is the most prominent risk factor for CDI, but other medication classes should also be watched vigilantly. Acid suppressive therapy (including proton pump inhibitors [PPI] and H2-receptor antagonists [H2RA]), has been associated with primary CDI [13]. Gastric acid protects humans by inhibiting bacterial overgrowth and preserving the normal microbiota of the gastrointestinal tract. While there is conflicting literature historically, more recent literature supports how decreased gastric acidity due to PPI therapy predisposes patients to CDI.

Kwok and colleagues found a significant association between PPI use and risk of developing CDI versus non-users in a pooled analysis of 39 studies (OR 1.74, 95% CI 1.47-2.85) [14]. The risk was increased when PPIs were combined with antibiotic therapy (OR 1.96, 95% CI 1.03-3.70). PPI use alone was associated with recurrent CDI (OR 2.51, 95% CI 1.16-5.44). This group found that H2RA use was associated with a lower risk of CDI than PPI use (OR 0.71, 95% CI 0.53-0.97). While it has also been reported that PPI use does not increase risk of CDI recurrence, more recent literature suggests recurrence does occur more frequently in patients on PPI therapy (OR 1.66, 95% CI 1.18-2.34) [15,16]. When this group evaluated all acid suppressive therapy (PPI and H2RA), there was not a significant association with recurrent CDI, implying the degree of acid suppression does make a difference in terms of overall infection risk. Extended duration of PPI therapy has also been associated with an increased risk of developing CDI [17].

Pharmacists should strongly encourage PPI cessation in patients on antimicrobial therapy, especially if the patient has a history of CDI. If the patient requires acid-suppressive for a valid indication (e.g., mechanical ventilation, severe coagulopathy, recent gastrointestinal bleed), then pharmacists can facilitate switching PPIs to H2RA’s when appropriate. The risks and benefits of acid-suppressive therapy should also be critically evaluated in patients with additional risk factors for CDI including age greater than 65, immunocompromised, serious illness, long length of stay, or previous gastrointestinal surgery or manipulation.

Pharmacists can help the health care team and patient tremendously by investigating why patients are on acid suppressive therapy and discuss stopping these medications with the patients and providers, if indicated. Multiple studies have indicated that more then 50% of patients on PPI’s do not have an evidence-based indication for therapy, meaning there is a lot of room for intervention and optimization with these medications [18.19]. One place to start is by reconciling orders from patients as they transition to the floor from the ICU; if their risk for stress ulcers has resolved and they were not on an acid suppressive agent at home, recommend discontinuation prior to transfer.

5. Drugs can cause diarrhea [20,21]

Finally, in a world where CDI is such a significant player in the hospital setting, it is important for providers to step back and consider hospitalized patients may have a cause of diarrhea that is not CDI.

The differential diagnosis for diarrhea is sometimes overlooked due to fear of CDI, and diagnostic testing is sent without ruling out other possible causes. The PCR testing for CDI is exquisitely sensitive, meaning it will result positive for nearly all Clostridium difficile, including colonization. Therefore, it is possible for a patient with a positive PCR to receive unnecessary treatment for colonization and be at risk for undertreatment of the true cause of his or her diarrhea. If a patient is complaining of diarrhea or multiple loose bowel movements, pharmacists have a great opportunity to evaluate the necessity of some medications. Streamline bowel regimens by discontinuing multiple agents and recommend transition from scheduled to as needed laxatives when appropriate.

Pharmacists can educate health care teams about medication-related causes of diarrhea. More than 700 drugs have diarrhea listed as an adverse reaction, but there are a few medications in particular that are very likely to cause diarrhea. The ones I commit to memory include:

Sorbitol-containing products * Metformin
Colchicine Digoxin
Lithium Chemotherapy
Itraconazole Magnesium
Laxatives Mycophenolate
Acid-suppressants Dicyclomine
NSAIDS Amitriptyline
Alendronate Hyoscyamine

*You can look up inactive ingredients for medications here:

Final thoughts

To combat such a deadly and prevalent infection, all healthcare workers need to work together, not just infectious diseases specialists. With these quick and easy medication-related tips, pharmacists can help connect antimicrobial stewardship, infection control, primary medical teams, infectious diseases consult services, and the patient together to optimize diagnosis and treatment of CDI.


1. Antibiotic Resistance Threats in the United States. Centers for Disease Control and Prevention website. drugresistance/pdf/ar-threats-2013-508.pdf. Published 2013. Accessed April 2, 2017.

2. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile infection in the United States. N Engl J Med. 2015;372(9):825-834

3. Cohen SH, Gerding DN, Johnson S, Kelly CP, Loo VG, McDonald LC, Pepin J, Wilcox MH; Society for Healthcare Epidemiology of America; Infectious Diseases Society of America. Clinical practice guidelines for Clostridium difficile infection in adults: 2010 update by the society for healthcare epidemiology of America (SHEA) and the infectious diseases society of America (IDSA). Infect Control Hosp Epidemiol. 2010 May;31(5):431-55.

4. Lewis BB, et al. Loss of microbiota-mediated colonization resistance to clostridium difficile infection with oral vancomycin compared with metronidazole. J Infect Dis. 2015;212:1656-65.

5. Deshpande A, et al. Effect of fidaxomicin versus vancomycin on susceptibility to intestinal colonization with vancomycin-resistant enterococci and klebsiella pneumoniae in mice. Antimicrob Agents Chemother. 2016;60:3988-93.

6. Stevens VW, Nelson RE, Schwab-Daugherty EM, et al. Comparative effectiveness of vancomycin and metronidazole for the prevention of recurrence and death in patients with Clostridium difficile infection. JAMA Intern Med. 2017;177:546-553.

7. Zar FA, et al. A comparison of vancomycin and metronidazole for the treatment of Clostridium difficile-associated diarrhea, stratified by disease severity. Clin Infect Dis. 2007;45:302-7.

8. Johnson S, et al. Vancomycin, metronidazole, or tolevamer for Clostridium difficile infection: results from two multinational, randomized, controlled trials. Clin Infect Dis. 2014;59:345-54.

9. Owens RC, Donskey CJ, Gaynes RP, Loo VG, Muto CA. Antimicrobial-associated risk factors for Clostridium difficile infection. Clin Infect Dis. 2008;46 Suppl 1:S19-31.

10. Vardakas KZ, Trigkidis KK, Boukouvala E, Falagas ME. Clostridium difficile infection following systemic antibiotic administration in randomised controlled trilas: a systematic review and meta-analysis. Int J Antimicrob Agents. 2016;48:1-10.

11. Dingle KE, Didelot X, Quan TP, et al. Effects of control interventions on Clostridium difficile infection in England: an observational study. Lancet Infect Dis. 2017;17(4):411-421.

12. Kavanagh K, Pan J, Marwick C, et al. Cumulative and temporal associations between antimicrobial prescribing and community-associated Clostridium difficile infection: population-based case-control study using administrative data. J Antimicrob Chemother. 2017;1193-1201.

13. Kyne L, Sougioultzis S, McFarland LV, Kelly CP. Underlying disease severity as a major risk factor for nosocomial Clostridium difficile diarrhea. Infect Control Hosp Epidemiol. 2002;23(11):653-9.

14. Kwok CS, Arthur AK, Anibueza CI, Singh S, Cavallazzi R, Loke YK. Risk of Clostridium difficile infection with acid suppressing drugs and antibiotics: meta-analysis. Am J Gastroenterol. 2012;107(7):1011-1019.

15. Freedberg DE, Salmasian H, Friedman C, Abrams JA. Proton pump inhibitors and risk for recurrent Clostridium difficile infection among inpatients. Am J Gastroenterol 2013; 108:1794.

16. Tariq R, Singh S, Gupta A, et al. Association of gastric acid suppression with Clostridium difficile infection: A systematic review and meta-analysis. JAMA Intern Med. 2017 [EPub ahead of print].

17. Barletta JF, El-Ibiary SY, Davis LE, et al. Proton Pump Inhibitors and the Risk for Hospital-Acquired Clostridium difficile Infection. Mayo Clin Proc 2013; 88:1085.

18. Choudhry MN, Soran H, Ziglam HM. Overuse and inappropriate prescribing of proton pump inhibitors in patients with Clostridium difficile-associated disease. QJM. 2008;101:445-8.

19. Mcdonald EG, Milligan J, Frenette C, Lee TC. Continuous Proton Pump Inhibitor Therapy and the Associated Risk of Recurrent Clostridium difficile Infection. JAMA Intern Med. 2015;175(5):784-91.

20. Chassany O, Michaux A, Bergmann JF. Drug-induced diarrhoea. Drug Saf. 2000;22:53-72.

21. Philip NA, Ahmed N, Pitchumoni CS. Spectrum of Drug-induced Chronic Diarrhea. J Clin Gastroenterol. 2017 Feb;51(2):111-117.



C Diff Foundation Celebrates National Volunteer Week 2017

National Volunteer Week, April 23 – 29th

The C Diff Foundation celebrates National Volunteer Week, April 23 – 29 to recognize more than 150 members of the C Diff Foundation Volunteer Members, including Volunteer Patient Advocates, have collectively donated more than 20,000 hours of volunteer service to the Foundation last year. The theme for this year’s celebration is “Sharing Time, Touching Lives.”

“Through the years the C Diff Foundation Volunteer Members have served as ambassadors of goodwill, service and compassion,” said Angelo Ortiz, C Diff Foundation’s Treasurer and Chairperson of  the Volunteer Patient Advocate Program

The C Diff Foundation, a 501(c) (3)  non-profit organization, established in 2012, and comprised of 100% volunteering professionals dedicated at supporting public health through education and advocating for C. difficile infection (CDI) prevention, treatments, environmental safety, and support worldwide

Not only do the volunteer members provide financial support for the C Diff Foundation’s programs — it is through their dedication and passion that continuously expands the Foundation’s mission.  Some volunteer patient advocates have their own unique C. diff. Survivor Journey which is shared with compassion, dedication, and caring hearts touching patients, students, fellow healthcare professionals,  and residents in the community every day.

Volunteer members will be recognized on November 9th & 10th  during the C Diff Foundation’s
5th Annual International C. diff. Awareness Conference and Health EXPO being hosted
in Las Vegas, NV.  During the annual event the “Volunteer Shooting Star” awards will
be presented along with numerous Volunteer Patient Advocate certificates for service hours.

“We are fortunate to have such kind and giving volunteers,” said Nancy C. Caralla, Foundress and Executive Director of the C Diff Foundation, “It is an honor to recognize those who have selflessly given so much to help educate, and promote the Foundation’s mission worldwide.”

The C Diff Foundation Volunteer Program was organized in 2012 to provide volunteer services, promote community understanding of Clostridium difficile (C. diff.) CDI  Infection Prevention, Treatments, Environmental Safety and Support and to raise funds for special C Diff Foundation patient/family programs.

The C Diff Foundation Members, with  the Volunteer Patient Advocates, successfully promote
C. diff. Awareness”  nationwide and in fifty-six  (56) countries and host a
U.S. Nationwide information Hot-Line (1-844-FOR-CDIF) to support health care providers, patients, and families guiding them through the difficulties caused by a C. diff. infection.

Volunteers Members serve in 12 different committees;  Volunteers host monthly teleconference support sessions; Provide Education about C. diff. infection and other linked healthcare topics through workshops, community events, and literature with patients, their families, and residents from villages to cities around the globe; Triage Nurses assist patients, families, clinicians with answers to prevention, treatment, environmental safety and support questions Monday – Friday 9:00 a.m. – 5:00 p.m. EST;  Register support session participants,; Provide IT management; Give clerical and social media assistance to various departments;  Provide a “Global Broadcasting Network” with with their educational radio
program,C. diff. Spores and More which broadcasts live every Tuesday at 1:00 p.m. EST. We are grateful for our sponsor Clorox Healthcare for making this program possible.  Each episode becomes a podcast and is accessible from the C. diff. Spores and More living library located on the main program page. Each November the Volunteer Members gather at the annual conference to both present and provide assistance in making the attendees feel welcome and expand their knowledge base on a variety of health topics that are linked to the main topic ~ Clostridium difficile infections.

For more information about the C Diff Foundation Volunteer Program, please call 919-201-1512 (toll free in USA 1-844-367-2343 ) or e-mail:


C Diff Foundation Volunteers — Helping Us  Help Others and The Beacon Of Light On the Other Side Of Pain and Suffering.