Tags

Type your tag names separated by a space and hit enter

A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment.
J Clin Microbiol 2015; 53(8):2570-4JC

Abstract

The horizontal transmission of Clostridium difficile in the hospital environment is difficult to establish. Current methods to detect C. difficile spores on surfaces are not quantitative, lack sensitivity, and are protracted. We propose a novel rapid method to detect and quantify C. difficile contamination on surfaces. Sponge swabbing was compared to contact plate sampling to assess the in vitro recovery of C. difficile ribotype 027 contamination (∼10(0), 10(1), or 10(2) CFU of spores) from test surfaces (a bed rail, a stainless steel sheet, or a polypropylene work surface). Sponge swab contents were concentrated by vacuum filtration, and the filter membrane was plated onto selective agar. The efficacy of each technique for the recovery of C. difficile from sites in the clinical environment that are touched at a high frequency was evaluated. Contact plates recovered 19 to 32% of the total contamination on test surfaces, whereas sponge swabs recovered 76 to 94% of the total contamination, and contact plates failed to detect C. difficile contamination below a detection limit of 10 CFU/25 cm(2) (0.4 CFU/cm(2)). In use, contact plates failed to detect C. difficile contamination (0/96 contact plates; 4 case wards), while sponge swabs recovered C. difficile from 29% (87/301) of the surfaces tested in the clinical environment. Approximately 74% (36/49) of the area in the vicinity of the patient was contaminated (∼1.34 ± 6.88 CFU/cm(2) C. difficile spores). Reservoirs of C. difficile extended to beyond the areas near the patient: a dirty utility room sink (2.26 ± 5.90 CFU/cm(2)), toilet floor (1.87 ± 2.40 CFU/cm(2)), and chair arm (1.33 ± 4.69 CFU/cm(2)). C. difficile was present on floors in ∼90% of case wards. This study highlights that sampling with a contact plate may fail to detect C. difficile contamination and result in false-negative reporting. Our sponge sampling technique permitted the rapid and quantitative measurement of C. difficile contamination on surfaces with a sensitivity (limit, 0 CFU) greater than that which is otherwise possible. This technique could be implemented for routine surface hygiene monitoring for targeted cleaning interventions and as a tool to investigate routes of patient-patient transmission in the clinical environment.

Authors+Show Affiliations

University College Hospital, Clinical Microbiology and Virology, London, United Kingdom shanom.ali@uclh.nhs.uk.University College Hospital, Clinical Microbiology and Virology, London, United Kingdom.University College Hospital, Clinical Microbiology and Virology, London, United Kingdom.

Pub Type(s)

Comparative Study
Evaluation Studies
Journal Article
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

26041892

Citation

Ali, Shanom, et al. "A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium Difficile Contamination in the Clinical Environment." Journal of Clinical Microbiology, vol. 53, no. 8, 2015, pp. 2570-4.
Ali S, Muzslay M, Wilson P. A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment. J Clin Microbiol. 2015;53(8):2570-4.
Ali, S., Muzslay, M., & Wilson, P. (2015). A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment. Journal of Clinical Microbiology, 53(8), pp. 2570-4. doi:10.1128/JCM.00376-15.
Ali S, Muzslay M, Wilson P. A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium Difficile Contamination in the Clinical Environment. J Clin Microbiol. 2015;53(8):2570-4. PubMed PMID: 26041892.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - A Novel Quantitative Sampling Technique for Detection and Monitoring of Clostridium difficile Contamination in the Clinical Environment. AU - Ali,Shanom, AU - Muzslay,Monika, AU - Wilson,Peter, Y1 - 2015/06/03/ PY - 2015/02/09/received PY - 2015/05/26/accepted PY - 2015/6/5/entrez PY - 2015/6/5/pubmed PY - 2016/5/18/medline SP - 2570 EP - 4 JF - Journal of clinical microbiology JO - J. Clin. Microbiol. VL - 53 IS - 8 N2 - The horizontal transmission of Clostridium difficile in the hospital environment is difficult to establish. Current methods to detect C. difficile spores on surfaces are not quantitative, lack sensitivity, and are protracted. We propose a novel rapid method to detect and quantify C. difficile contamination on surfaces. Sponge swabbing was compared to contact plate sampling to assess the in vitro recovery of C. difficile ribotype 027 contamination (∼10(0), 10(1), or 10(2) CFU of spores) from test surfaces (a bed rail, a stainless steel sheet, or a polypropylene work surface). Sponge swab contents were concentrated by vacuum filtration, and the filter membrane was plated onto selective agar. The efficacy of each technique for the recovery of C. difficile from sites in the clinical environment that are touched at a high frequency was evaluated. Contact plates recovered 19 to 32% of the total contamination on test surfaces, whereas sponge swabs recovered 76 to 94% of the total contamination, and contact plates failed to detect C. difficile contamination below a detection limit of 10 CFU/25 cm(2) (0.4 CFU/cm(2)). In use, contact plates failed to detect C. difficile contamination (0/96 contact plates; 4 case wards), while sponge swabs recovered C. difficile from 29% (87/301) of the surfaces tested in the clinical environment. Approximately 74% (36/49) of the area in the vicinity of the patient was contaminated (∼1.34 ± 6.88 CFU/cm(2) C. difficile spores). Reservoirs of C. difficile extended to beyond the areas near the patient: a dirty utility room sink (2.26 ± 5.90 CFU/cm(2)), toilet floor (1.87 ± 2.40 CFU/cm(2)), and chair arm (1.33 ± 4.69 CFU/cm(2)). C. difficile was present on floors in ∼90% of case wards. This study highlights that sampling with a contact plate may fail to detect C. difficile contamination and result in false-negative reporting. Our sponge sampling technique permitted the rapid and quantitative measurement of C. difficile contamination on surfaces with a sensitivity (limit, 0 CFU) greater than that which is otherwise possible. This technique could be implemented for routine surface hygiene monitoring for targeted cleaning interventions and as a tool to investigate routes of patient-patient transmission in the clinical environment. SN - 1098-660X UR - https://www.unboundmedicine.com/medline/citation/26041892/A_Novel_Quantitative_Sampling_Technique_for_Detection_and_Monitoring_of_Clostridium_difficile_Contamination_in_the_Clinical_Environment_ L2 - http://jcm.asm.org/cgi/pmidlookup?view=long&pmid=26041892 DB - PRIME DP - Unbound Medicine ER -