Primary care clinics can be a source of exposure to virulent Clostridium (now Clostridioides) difficile: An environmental screening study of hospitals and clinics in Dallas-Fort Worth region

PLoS One. 2019 Aug 15;14(8):e0220646. doi: 10.1371/journal.pone.0220646. eCollection 2019.

Abstract

C. difficile is an endospore-forming pathogen, which is becoming a common cause of microbial health-care associated gastrointestinal disease in the United States. Both healthy and symptomatic patients can shed C. difficile spores into the environment, which can survive for long periods, being resistant to desiccation, heat, and disinfectants. In healthcare facilities, environmental contamination with C. difficile is a major concern as a potential source of exposure to this pathogen and risk of disease in susceptible patients. Although hospital-acquired infection is recognized, community-acquired infection is an increasingly recognized health problem. Primary care clinics may be a significant source of exposure to this pathogen; however, there are limited data about presence of environmental C. difficile within clinics. To address the potential for primary care clinics as a source of environmental exposure to virulent C. difficile, we measured the frequency of environmental contamination with spores in clinic examination rooms and hospital rooms in Dallas-Fort Worth (DFW) area of Texas. The ribotypes and presence of toxin genes from some environmental isolates were compared. Our results indicate primary care clinics have higher frequencies of contamination than hospitals. After notification of the presence of C. difficile spores in the clinics and an educational discussion to emphasize the importance of this infection and methods of infection prevention, environmental contamination in clinics was reduced on subsequent sampling to that found in hospitals. Thus, primary care clinics can be a source of exposure to virulent C. difficile, and recognition of this possibility can result in improved infection prevention, potentially reducing community-acquired C. difficile infections and subsequent disease.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Clostridioides difficile / isolation & purification*
  • Clostridium Infections / prevention & control*
  • Cross Infection / prevention & control*
  • Health Facilities*
  • Humans
  • Primary Health Care
  • Texas

Associated data

  • Dryad/10.5061/dryad.6nk2n87

Grants and funding

This study was funded by DFWHC Foundation Hospital Engagement Network, under contract with the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, Contract Number HHSM-500-2012-0025 Hospital Engagement Network Contractor for Partnership for Patients Initiative. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.