ADVANCEMENT OF THE SCIENCE
Role of the Household Environment in Transmission of Clostridioides difficile Infection: A Scoping Review
provided to patients on discharge, it did not contain adequate direction for patients to remove or inactivate C. dicile spores from their household environment. Most (66.7%, 30 out of 45) of the infection control profes- sionals who responded, however, thought that the household environment was impor- tant in the transmission of C. dicile (Egan et al., 2019). Nonetheless, one of the barriers to providing advice for an eective house- hold hygiene protocol was a lack of knowl- edge about the role of the environment in the transmission of CDI in the household (Egan et al., 2019). Fecal–oral transmission of enteric patho- gens likely occurs in the household environ- ment (Curtis et al., 2003) and routine clean- ing could be insucient to remove pathogens (including C. dicile ) that can be present when a household member has an infection (Kagan et al., 2002). Researchers have specu- lated that the same principles of transmission and control of C. dicile that apply to health- care settings should apply also to households (Girotra et al., 2013). Specific studies of C. dicile transmission in the household envi- ronment, however, seem to be lacking. The objective of this scoping review was to describe the volume and breadth of scientific literature related to transmission of C. dicile in the household environment. Catherine D. Egan, MBA, CPHI(C), CIC Department of Pathobiology, University of Guelph Conestoga College Jan M. Sargeant, MSc, DVM, PhD, FCAHS Zoonoses, University of Guelph J. Scott Weese, DVSc, DVM, Dipl. ACVIM Department of Pathobiology and Centre for Public Health and Zoonoses, University of Guelph Andria Jones-Bitton, DVM, PhD Department of Population Medicine and Centre for Public Health and Department of Population Medicine and Centre for Public Health and Zoonoses, University of Guelph Shawn E. Zentner, MPH, CPHI(C) Wellington–Dufferin–Guelph Public Health
+:;9*,; The environment plays a role in healthcare-associated Clostridioides (formerly Clostridium ) dicile infection (CDI); however, the role of the environment in community-associated CDI is unknown. The objective of this scoping review was to describe the literature related to the transmission of C. dicile in the household environment. We conducted searches of four electronic health and science databases to identify relevant studies. In total, 39 articles published between 1981 and 2020 met the a priori inclusion criteria. Slightly over one half (51.3%, 20 out of 39) of the articles were nonsystematic review articles and thus we excluded them from the synthesis of results. Overall, we included 19 articles in the synthesis of results. None of the studies were experimental studies. Studies assessed or estimated the prevalence of C. dicile on household surfaces, colonization of household members (human and animal), or the risk of transmission in the household. This scoping review provides an overview of the global literature related to the role of the household environment in transmission of C. dicile . We found a lack of research in this area. Further studies are needed and ideally would be designed to follow household members over time and to test the eectiveness of interventions such as targeted hygiene protocols.
Introduction Clostridioides dicile is a pathogen that has been recognized for decades. Historically, C. dicile infection (CDI) has been regarded as a healthcare-associated infection (Roth, 2016). Cases of CDI, however, are increas- ingly being identified in individuals without traditional risk factors for CDI (Delate et al., 2015), suggesting that infections are related to exposure in community settings. C. dicile spores survive in the environ- ment for several months, and transmission of C. dicile has been linked to contami- nated surfaces and the hands of healthcare professionals in healthcare settings (Kim et
al., 1981). Infection prevention and control practices in healthcare settings include strict environmental cleaning and disinfection pro- tocols. People with CDI can excrete C. dicile spores for many weeks posttreatment (Jinno et al., 2012; Riggs et al., 2007; Sethi et al., 2010), which is generally postdischarge from the healthcare setting. Therefore, it is likely that contamination of the household environment occurs, posing a risk to household inhabitants (both human and animal), including a risk of reinfection for the index case. A survey of infection control profession- als in hospitals in Ontario, Canada, deter- mined that if household hygiene advice was
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