Have you housebroken your C.diff yet?

Whenever I start reading the journals, which I do a lot, I think about how new research affects my practice.  Lately I’ve been mulling over the studies that discuss environmental contamination and C.difficile.  So here’s what I’ve assembled in my brain so far:

1.  It seems that many patients in hospitals who develop CDI have a strain of the bacteria that doesn’t match any other known patient with CDI when the organism is typed.  So all these cases we call “hospital-acquired” may not really be—even if it was x number of days after admission. (Yes, I know this doesn't consider the role of antibiotics.)
2. When samples are taken from the environment of known CDI patients, some of the found strains don’t match the patient.
3.  Asymptomatic carriers of toxigenic C.diff contaminate their environment.

So it appears that there is literally a crapload of C.diff all over the hospital.  So maybe you’re like me and your housekeeping staff is using one disinfectant for the regular rooms and then the special disinfectant for the C.diff rooms, right? And maybe you’ve got one of those silly million-dollar UV robots that administration was lured into buying, and your EVS staff are pushing that thing all over the dang facility, making sure to get the C.diff and precaution rooms.  

But you don’t know which rooms those are anymore!  It seems the truth is that C.diff is in way more places than you thought, because you apparently forgot to train your C.diff to stay in those specific rooms where the patient had CDI.  I can’t imagine how C.diff got from one room to another, because I’m sure your hand hygiene rates are pretty close to 100%, right?  Soap and water every time in those rooms, right? And you didn’t even consider the asymptomatic carriers who are shedding in the room next door. 

Me neither.

So for a while I’d been bouncing around the idea of a one-and-done disinfectant for exactly this reason.  I tell my staff “Precautions patients are just the ones we know about.”   We aren’t testing everyone for everything.  Wouldn’t you rather have a product that takes care of everything, even when you don’t know what or where the ‘everything’ is?  I would.

So maybe this is the post that I would have called “I heart Vendors”.  Because I do.  When I started in IC, my predecessor turned over the business cards of all our sales reps, pointing out who I’d need to keep in touch with.  I know some people avoid them, but I took every call and every meeting during my first year in IC, and I still do.   I want to hear about their product.  Really.

Your vendors or sales reps know their product, they know what it can do, they know what the research says it can do, and they know exactly how it compares to their competitor.  They know what it costs for you to buy and maintain, and how that compares to what you’re doing now.  They have formulas, and white papers, and samples.  The time it would take me to get all that info on my own is, well, ….well, it’s not even possible, given my schedule most of the time.   Yes, it comes with marketing and a sales pitch.  But if you’re educated, you know what’s valuable information and what isn’t.  

So anyways, I think it’s time to move to a new disinfectant, since my C.diff is not housebroken and apparently roams all over the place when I’m not looking. Does yours?

[Related: A source for info on each type of disinfectant.  Disinfectant report cards on Talk Clean to Me blog.]