Study: Surgical Gowns Remain Contaminated with C. difficile After Disinfectant

By Dorothy L. Tengler via Multibriefs

Clostridium difficile infects 500,000 Americans and kills 29,000 each year. Commonly affecting older adults in hospitals and long-term care facilities, symptoms of infection include diarrhea, fever, rapid heartbeat, inflammation of the intestines, and kidney failure.

A survey by the Association for Professionals in Infection Control found that the C. difficile incidence rate of 13 out of every 1,000 inpatients either infected or colonized with C. difficile was 6.5 to 20 times greater than previous incidence estimates.

Numerous studies have shown that standard cleaning practices leave significant levels of contamination on operating room surfaces and can contribute to surgical site infections, the most expensive hospital acquired infection to treat. In a study of 28 hospitals in the Southeast, C. difficile has surpassed methicillin-resistant Staphylococcus aureus (MRSA) as the most prevalent cause of hospital acquired infections. C. difficile, the primary cause of antibiotic-associated diarrhea,was found to be 25% more common than MRSA.

C. difficile spores are resistant to many commonly used disinfectants, sanitizers, and cleaning agents, including alcohol-based hand sanitizers. Surgical gowns and stainless steel often remain contaminated with C. difficile even after treatment with a recommended disinfectant.

According to Tina Joshi, BSci, Ph.D., and lecturer in molecular microbiology at the University of Plymouth in England, because the spores can grow after decontamination, the spores of C. difficile are becoming resistant, and decontamination measures in hospitals need to be reconsidered.

This new research with Joshi and colleagues was the result of a case in an American hospital in which gowns were found to be contaminated with deadly strain of 027 C. difficile. The researchers proved the ability of C. difficile to adhere to hospital gowns by applying spores in sterilized water (1 million per ml) directly to the surgical gowns in liquid for 10 seconds, 30 seconds, 1 minute, 5 minutes, and 10 minutes before removing and discarding.

This method mimicked the transfer of infectious bodily fluids in the clinical setting to assess potential transmission to patients. The researchers found that the number of spores recovered from the gowns did not increase with contact time, which suggests that the spore transfer between surfaces occurred within the first 10 seconds of contact.

The gowns were then treated with disinfectant containing 1,000 parts per million of chlorine for 10 minutes. But the disinfectant failed to eliminate C. difficile from the gowns, suggesting that the gowns can pick up and retain the spores.

In addition, the spores on stainless steel and vinyl flooring also remained viable after treatment with disinfectant. According to Joshi, this work can be applied to hospitals anywhere in the world and may help inform future guidelines on infection control and biocides.

Dorothy L. Tengler, MA, is a freelance medical writer/communication specialist with nearly 20 years of experience in the pharmaceutical and medical communication industries. She has developed educational and medical marketing materials, including monographs, slide kits, health articles, primary and review manuscripts, and pharmaceutical sales training materials.