UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.

Michelle J Alfa¹^,2^,3 , Christine Dueck¹ , Nancy Olson³ , Pat DeGagne² , Selena Papetti³ , Alana Wald² , Evelyn Lo¹ and Godfrey Harding¹^,2

¹Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

²Diagnostic Services of Manitoba, Microbiology Discipline, St. Boniface General Hospital site, Winnipeg, Manitoba, Canada

³Microbiology laboratory, St. Boniface Research Centre, Winnipeg, Manitoba, Canada

author email corresponding author email

BMC Infectious Diseases 2008, 8:64doi:10.1186/1471-2334-8-64


Published:	12 May 2008

Abstract

Background

An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.

Methods

The UVM was applied to the toilets of patients who were on isolation precautions due to Clostridium difficile-associated diarrhea (CDAD) as well as for patients who were not on isolation precautions. Cleaning was visually scored using a numeric system where 0, 1, 2, and 3 represented; no, light, moderate or heavy residual UVM. Rodac plates containing CDMN selective agar were used to test for the presence of C. difficile on the surfaces of patient's toilets.

Results

Despite twice daily cleaning for the toilets of patients who were on CDAD isolation precautions, the average cleaning score was 1.23 whereas the average cleaning score for toilets of patients not on isolation precautions was 0.9. Even with optimal cleaning (UVM score of 0) C. difficile was detected from 33% of the samples taken from toilets of patients with CDAD (4% detection in toilet samples from patients who had diarrhea not due to CDAD).

Conclusion

Our data demonstrated the value of UVM for monitoring the compliance of housekeeping staff with the facility's toilet cleaning protocol. In addition to providing good physical cleaning action, agents with some sporicidal activity against C. difficile may be needed to effectively reduce the environmental reservoir.