Clostridium difficile as a nosocomial pathogen.

Abstract

Patients admitted to a 19-bed floor with intermediate nursing care were studied for the onset of Clostridium difficile-associated diarrhoea during a six-month period (181 calendar days) in 1986-87. All admitted patients were reviewed weekly and followed after discharge from the study unit to other inpatient services. Multiple items in the environment of five patients' rooms were sampled bacteriologically for the presence of C. difficile weekly during the study period. Three of the rooms were selected for study because of a higher prevalence of C. difficile associated diarrhoea in the prior three years and two were selected because no cases had been discovered previously in these rooms ('control rooms'). Nine of 521 patients admitted to this unit developed C. difficile diarrhoea (1.73 cases/100 patients admitted) versus 0.30/100 patients admitted to all other sites in our hospital (24 of 7970 other patients). This represented respectively 3.91 cases per 1000 patient days on this floor versus 0.37 patients/1000 patient days throughout the hospital. Seven of the C. difficile diarrhoea cases were associated with stay in the C. difficile associated rooms, versus two cases in the two 'control rooms'. C. difficile was isolated from the toilet seats, bedpan hopper, night stands or food trays. Of some 1955 cultures taken, only 1.9% overall were positive for C. difficile.