ISOLATION and ROOM CLEANING

Isolation Measures for Patients With C.diff. infection (CDI):

Should private rooms and/or dedicated toilet facilities be used for isolated patients with CDI?

Recommendations
  1. Accommodate patients with CDI in a private room with a dedicated toilet to decrease transmission to other patients. If there is a limited number of private single rooms, prioritize patients with stool incontinence for placement in private rooms (strong recommendation, moderate quality of evidence).
  2. If cohorting is required, it is recommended to cohort patients infected or colonized with the same organism(s)—that is, do not cohort patients with CDI who are discordant for other multidrug-resistant organisms such as methicillin-resistant Staphylococcus aureus or vancomycin-resistant Enterococcus (strong recommendation, moderate quality of evidence).

Should gloves and gowns be worn while caring for isolated CDI patients?

Recommendation
  1. Healthcare personnel must use gloves (strong recommendation, high quality of evidence) and gowns (strong recommendation, moderate quality of evidence) on entry to a room of a patient with CDI and while caring for patients with CDI.

When should isolation be implemented?

Recommendation
  1. Patients with suspected CDI should be placed on preemptive contact precautions pending the C. difficile test results if test results cannot be obtained on the same day (strong recommendation, moderate quality of evidence).

How long should isolation be continued?

Recommendations
  1. Continue contact precautions for at least 48 hours after diarrhea has resolved (weak recommendation, low quality of evidence).
  2. Prolong contact precautions until discharge if CDI rates remain high despite implementation of standard infection control measures against CDI (weak recommendation, low quality of evidence).

What is the recommended hand hygiene method (assuming glove use) when caring for patients in isolation for CDI?

Recommendations
  1. In routine or endemic settings, perform hand hygiene before and after contact of a patient with CDI and after removing gloves with either soap and water or an alcohol-based hand hygiene product (strong recommendation, moderate quality of evidence).
  2. In CDI outbreaks or hyperendemic (sustained high rates) settings, perform hand hygiene with soap and water preferentially instead of alcohol-based hand hygiene products before and after caring for a patient with CDI given the increased efficacy of spore removal with soap and water (weak recommendation, low quality of evidence).
  3. 3. Handwashing with soap and water is preferred if there is direct contact with feces or an area where fecal contamination is likely (eg, the perineal region) (good practice recommendation).

Should patient bathing interventions be implemented to prevent CDI?

Recommendation
  1. Encourage patients to wash hands and shower to reduce the burden of spores on the skin (good practice recommendation).

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CLEANING

Should noncritical devices or equipment be dedicated to or specially cleaned after being used on the isolated patient with CDI?

Recommendation
  1. Use disposable patient equipment when possible and ensure that reusable equipment is thoroughly cleaned and disinfected, preferentially with a sporicidal disinfectant that is equipment compatible (strong recommendation, moderate quality of evidence).

What is the role of manual, terminal disinfection using a C. difficile sporicidal agent for patients in isolation for CDI?

Recommendation
  1. Terminal room cleaning with a sporicidal agent should be considered in conjunction with other measures to prevent CDI during endemic high rates or outbreaks, or if there is evidence of repeated cases of CDI in the same room (weak recommendation, low quality of evidence).

Should cleaning adequacy be evaluated?

Recommendation
  1. Incorporate measures of cleaning effectiveness to ensure quality of environmental cleaning (good practice recommendation).

What is the role of automated terminal disinfection using a method that is sporicidal against C. difficile?

Recommendation
  1. There are limited data at this time to recommend use of automated, terminal disinfection using a sporicidal method for CDI prevention (no recommendation).

What is the role of daily sporicidal disinfection?

Recommendation
  1. Daily cleaning with a sporicidal agent should be considered in conjunction with other measures to prevent CDI during outbreaks or in hyperendemic (sustained high rates) settings, or if there is evidence of repeated cases of CDI in the same room (weak recommendation, low quality of evidence).

Should asymptomatic carriers of C. difficile be identified and isolated if positive?

Recommendation
  1. There are insufficient data to recommend screening for asymptomatic carriage and placing asymptomatic carriers on contact precautions (no recommendation).

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