JAMA Netw Open
Environmental surfaces, HCP hands play major role in C. difficile transmission
April 9, 2025

Study details: This longitudinal, observational study was conducted over 13 weeks in 2018 in two ICUs in Utah. Daily culture-based sampling was performed on patient body sites, room environmental surfaces, healthcare personnel (HCP) hands, and shared environmental surfaces. Both toxigenic and nontoxigenic C. diff strains were analyzed using whole genome sequencing to identify transmission clusters.
Results: Out of 278 unique ICU admissions, 177 patients consented to body site sampling. A total of 7,000 samples were collected, revealing that nearly 8% of patients had C. diff linked to other admissions. Additionally, 57% of transmission clusters bridged nonoverlapping patient stays. Including environmental surfaces and HCP hands, a 3.6-fold higher C. diff movement was identified compared with patient sampling alone, indicating environmental surfaces as significant reservoirs.
Clinical impact: The study challenges the notion that nosocomial transmission isn't a primary source of C. diff acquisition. It underscores the importance of hand hygiene and environmental decontamination in infection control measures.
Source:
Keegan LT, et al. (2025, April 1). JAMA Netw Open. Environmental and Health Care Personnel Sampling and Unobserved Clostridium difficile Transmission in ICU. https://pubmed.ncbi.nlm.nih.gov/40184069/
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