A new study reveals the hidden spread of C. diff in the intensive care unit

One of the most common healthcare-related infections spreads within intensive care units (ICUs) more than three times as much as previously thought, a new study found.

Clostridium difficile It was called an infection C. diff-causes diarrhea, abdominal painFever and fatal in about 6% of cases in the United States, the disease is highly contagious, but in previous studies, direct patient-to-patient transmission appears to be rare. Now, by tracking bacteria through hospital environments, not just patients, scientists have discovered previously undetected movements C. diff Bacteria through the hospital environment.

There is a lot we haven't seen under the hood. And ignoring it can put the patient at unnecessary risk. ”

Michael Rubin, MD, PhD, epidemiologist and infectious disease Spencer Fox Eccles School of Utah Experts, Senior Author of Research

The results are published on Jama Network Open.

Bacteria movements in the environment are common

To track infections across healthcare settings, researchers say C. diff Collect thousands of samples from nearly 200 patients across two intensive care units (ICUs) from the surface of the hospital room and from the hands of healthcare providers.

Researchers used whole-genomic DNA sequencing to accurately track the movement of bacteria. There are genetic differences between different bacterial samples, and researchers measured it to track movements C. diff Around the medical facility. The team was even able to use these differences to determine whether two bacterial samples came from the same patient rather than being acquired independently from sources outside the hospital.

The team detected bacteria in 10% of the patient's ICU and was not in the patient's body or in the room immediately nearby. And in most of these cases, the bacteria are genetically identical to those found in another patient or in another patient's room, suggesting bacteria born from the same patient rather than coming from two different sources.

“We find almost the same amount of patient-to-patient transmission as previous studies,” explains Dr. Lindsay Keegan, Associate Professor of Epidemiology at U of U Health and the study's first author. “But what we think is novel is that there is more movement. C. diff Surface to surface to patient, and from patient to surface than previously discovered. ”

To clarify long-term spread

By simultaneously tracking various bacterial varieties in patients, provider hands, and environments, researchers have revealed cases of potential transmission that have not been caught up in other ways.

In particular, the team found that in more than half of the potential transmission events, the two patients involved were separated for several weeks and not even in the hospital. The key to this paradox is C. diff: Bacteria can withstand common antibacterial measurements such as alcohol-based cleansers and survive for a long time outside the body. One bacteria can inadvertently move to the surface of another room, where they cannot wait for another patient and are not detected.

Importantly, not everything C. diff Bacteria cause disease, and most C. diff The diffused researchers observed that harmless bacterial varieties were involved. However, researchers say it spreads the cause of non-silence C. diff It suggests that it can cause similar diseases C. diff It may not be detected.

How to prevent infection

Researchers say they hope their results will lead to stronger precautions to prevent spreading diseases in hospitals.

“What I hope from this paper is for healthcare providers to place more emphasis on infection prevention measures and adhere to them whenever possible,” Rubin says. It is important to use personal protective equipment such as gloves and gowns and practice strict hand hygiene, he adds. “These are ways to help disrupt this type of invisible transmission.”

Results announced in Jama Network Open “As no sampling and observations of the environment and healthcare professionals and medical personnel. Clostridium difficile Transmission in the ICU. ”

This study was funded by National Institutes of Health/National Institute of Allergy and Infectious Diseases Grant 1K01AI159519 and Disease Control and Prevention Grant 5U01CK000585 and HHSD-200-2011-42039. Content is solely the author's responsibility and does not necessarily represent the official views of the National Institutes of Health.

Keegan reported receiving a grant from the Centers for Disease Control and Prevention (CDC) for forecasting and outbreak analysis of submitted work. Dr. Karim Khader reported that he received grants from the Bureau of Veterans Affairs (VA) and Biomerieux for non-work submitted. Rubin reported that he would receive grants from the CDC and VA for anything other than the work submitted.