TY - JOUR
T1 - Primary care clinics can be a source of exposure to virulent Clostridium (now Clostridioides) difficile
T2 - An environmental screening study of hospitals and clinics in Dallas-Fort Worth region
AU - Simecka, Jerry W.
AU - Fulda, Kimberly G.
AU - Pulse, Mark
AU - Lee, Joon hak
AU - Vitucci, John
AU - Nguyen, Phung
AU - Taylor, Patricia
AU - Filipetto, Frank
AU - Espinoza, Anna M.
AU - Sharma, Sushma
N1 - Funding Information:
This study was funded by DFWHC Foundation Hospital Engagement Network, under contract with the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services, Contract Number HHSM-500-2012-0025 Hospital Engagement Network Contractor for Partnership for Patients Initiative. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. This study was funded by DFWHC Foundation Hospital Engagement Network, under contract with the Centers for Medicare and Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. Contract Number HHSM-500-2012-0025 Hospital Engagement Network Contractor for Partnership for Patients Initiative. We would like to thank Dallas-Fort Worth Hospital Council Education and Research Foundation’s Board and President Kristin Jenkins for their support and approval for this project. We would also like to thank Randi Proffitt-Leyva, Michelle Lee, MS, and the NorTex research assistants for their help with collecting samples. We would also like to thank the PreClinical Services personnel for their assistance with the laboratory processing of samples.
Publisher Copyright:
© 2019 Simecka et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
PY - 2019/8/1
Y1 - 2019/8/1
N2 - C. difficile is an endospore-forming pathogen, which is becoming a common cause of microbial health-care associated gastrointestinal disease in the United States. Both healthy and symptomatic patients can shed C. difficile spores into the environment, which can survive for long periods, being resistant to desiccation, heat, and disinfectants. In healthcare facilities, environmental contamination with C. difficile is a major concern as a potential source of exposure to this pathogen and risk of disease in susceptible patients. Although hospital-acquired infection is recognized, community-acquired infection is an increasingly recognized health problem. Primary care clinics may be a significant source of exposure to this pathogen; however, there are limited data about presence of environmental C. difficile within clinics. To address the potential for primary care clinics as a source of environmental exposure to virulent C. difficile, we measured the frequency of environmental contamination with spores in clinic examination rooms and hospital rooms in Dallas-Fort Worth (DFW) area of Texas. The ribotypes and presence of toxin genes from some environmental isolates were compared. Our results indicate primary care clinics have higher frequencies of contamination than hospitals. After notification of the presence of C. difficile spores in the clinics and an educational discussion to emphasize the importance of this infection and methods of infection prevention, environmental contamination in clinics was reduced on subsequent sampling to that found in hospitals. Thus, primary care clinics can be a source of exposure to virulent C. difficile, and recognition of this possibility can result in improved infection prevention, potentially reducing community-acquired C. difficile infections and subsequent disease.
AB - C. difficile is an endospore-forming pathogen, which is becoming a common cause of microbial health-care associated gastrointestinal disease in the United States. Both healthy and symptomatic patients can shed C. difficile spores into the environment, which can survive for long periods, being resistant to desiccation, heat, and disinfectants. In healthcare facilities, environmental contamination with C. difficile is a major concern as a potential source of exposure to this pathogen and risk of disease in susceptible patients. Although hospital-acquired infection is recognized, community-acquired infection is an increasingly recognized health problem. Primary care clinics may be a significant source of exposure to this pathogen; however, there are limited data about presence of environmental C. difficile within clinics. To address the potential for primary care clinics as a source of environmental exposure to virulent C. difficile, we measured the frequency of environmental contamination with spores in clinic examination rooms and hospital rooms in Dallas-Fort Worth (DFW) area of Texas. The ribotypes and presence of toxin genes from some environmental isolates were compared. Our results indicate primary care clinics have higher frequencies of contamination than hospitals. After notification of the presence of C. difficile spores in the clinics and an educational discussion to emphasize the importance of this infection and methods of infection prevention, environmental contamination in clinics was reduced on subsequent sampling to that found in hospitals. Thus, primary care clinics can be a source of exposure to virulent C. difficile, and recognition of this possibility can result in improved infection prevention, potentially reducing community-acquired C. difficile infections and subsequent disease.
UR - http://www.scopus.com/inward/record.url?scp=85070701306&partnerID=8YFLogxK
U2 - 10.1371/journal.pone.0220646
DO - 10.1371/journal.pone.0220646
M3 - Article
C2 - 31415582
AN - SCOPUS:85070701306
SN - 1932-6203
VL - 14
JO - PLoS ONE
JF - PLoS ONE
IS - 8
M1 - e0220646
ER -