Transmission of C. difficile: Asymptomatic carriers are also a risk

A new paper from Canada that has examined the effect of screening and isolation for asymptomatic carriers of toxigenic C. difficile has just been released onto the JAMA Internal Medicine website. In this study, 4.8% of patients screened were found to be carrying the tbD gene and these patients were part of an intervention group that included isolation, but not in the traditional sense as shared bays were permissible however the curtains remained drawn. The effect of this intervention was not immediate however there was a significant decrease in trend over time of 7% per 4-week period and the authors have suggested that based on previous data they would have expected to see 101 cases over the intervention period, whereas they actually saw 38 cases, a 63% decrease. Asymptomatic carriage has for some time been suggested as a significant risk factor for transmission, as other studies which show high skin contamination from these patients have demonstrated, including studies that have demonstrated a risk from healthcare environments contaminated by asymptomatic patients. Keeping disinfectants with proven sporicidal activity in reserve for only ‘cases’ of C. difficile may mean that opportunities for reducing the bioburden from asymptomatic patients are missed.