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Clostridium difficile: One of the most Difficult Health Acquired Infections to Eradicate

January 18, 2019

Clostridium difficile (C. diff) is one of the most difficult healthcare-associated infectious agents to eradicate because of the limited number of antibiotics or disinfectants that have been found to be effective against this bacterium.  The limited number of either antibiotics or disinfectants can be attributed primarily to the category of bacteria that Clostridium difficile is classified as: a spore forming bacteria.   When the environment becomes hostile, spore forming bacteria like Clostridium difficile forms spores that are resistant to heat and chemical disinfectants allowing them to survive when most common bacteria would die.  Later when the environment becomes more favorable for bacteria, the Clostridium difficile returns to its original state and where it begins to infect and multiply again.   Currently, only two antibiotics are recommended and approved for treatment of Cdiff:  vancomycin, and fidaxomicin.   In about twenty percent of patients treated for Cdiff infections, the infection returns.  In a 2011 study published in the New England Journal of Medicine (372; 825-834) in 2015, it was estimated that the number of C. diff infection in the US exceeded 450,000 and resulted in over 29,000 deaths.  Since this study was published the incidence for C. diff infections have leveled off and in some regions C. diff infections have slightly declined.  Although most C. diff patients survive their infection; C. diff remains a challenge for infection control practitioners across the country.  Burden of Clostridium difficile Infection in the United States. New England Journal of Medicine 2015, 372: 825 – 834.


Clinical symptoms for C. diff include: watery diarrhea, fever, loss of appetite, nausea and abdominal pain/tenderness.  Obviously, C. diff can disrupt our digestive systems.  C. diff can spread when care givers and medical professionals touch contaminated surfaces.  The persistent C. diff and C. diff spores can then infect others within a healthcare facility whether that facility is a clinic, hospital or nursing home.  Both the CDC and APIC have studies that demonstrate that a robust hand hygiene regime can reduce the incidence of infections (including C. diff).  Mason products like Nobac® Instant Foam Hand Sanitizer 10X Concentrate, and Nobac® AB-F Antibacterial Foam Hand Soap concentrates utilizing the Nobac® BZK NF/USP as the active ingredient can be an important tool in combatting HAIs, including C. diff.


For disinfection of C. diff contaminated surfaces, the CDC recommends using EPA registered disinfectants.  However, not all EPA disinfectants are effective against C. diff.  Because of the seriousness of C. diff infections, EPA has published a list of effective disinfectants; List K: EPA’s Registered Antimicrobial Products Effective against Clostridium difficile Spores.

Maguard® 5626 based on peracetic acid is a Mason product found on the EPA List K.  As aforementioned, bacteria spores are resistant to chemical disinfectants. Common hospital grade disinfectants based on quaternary ammonium compounds are ineffective against Clostridium difficile spores. Some hospital grade disinfectants make claims of effectiveness against Clostridium difficile but only in the vegetative state; the bacteria spores remain.  To properly disinfect a surface contaminated with C. diff requires a potent disinfectant capable of delivering robust effectiveness to eliminate Clostridium difficile spores.

Reducing HAI infections can be challenging when C. diff is one of the targeted infectious agents.  A good hand hygiene program based on Mason Nobac® products and good housekeeping are essential tools in reducing HAIs.  Mason hand hygiene products and the Maguard® 5626 should be part of every healthcare facility’s repertoire.



Clostridium difficile