Environmental control to reduce transmission of Clostridium difficile

Restrictive antibiotic policies and infection control measures have been sh own to reduce the incidence of Clostridium difficile-associated diarrhea (C DAD) among hospitalized patients. To date, the role of environmental disinf ectants in reducing nosocomial CDAD rates has not been wed studied. In a be fore-and-after intervention study, patients in 3 units were evaluated to de termine if unbuffered 1:10 hypochlorite solution is effective as an environ mental disinfectant in reducing the incidence of CDAD, Among 4252 patients, the incidence rate of CDAD for bone marrow transplant patients decreased s ignificantly, from 8.6 to 3.3 cases per 1000 patient-days (hazard ratio, 0. 37; 95% confidence interval, 0.19-0.74), after the environmental disinfecta nt was switched from quaternary ammonium to 1:10 hypochlorite solution in t he rooms of patients with CDAD, Reverting later to quaternary ammonium solu tion increased the CDAD rate to 8.1 cases per 1000 patient-days. No reducti on in CDAD rates was seen among neurosurgical intensive care unit and gener al medicine patients, for whom baseline rates were 3.0 and 1.3 cases per 10 00 patient-days, respectively, Unbuffered 1:10 hypochlorite solution is eff ective in decreasing patients' risk of developing CDAD in areas where CDAD is highly endemic. Presumed mechanisms include reducing the environmental b urden and the potential for C. difficile transmission among susceptible pat ients.