Recommendations
Table 3. Summary of Recommendations to Prevent CDI
Essential Practices: should be adopted by all acute-care hospitals unless a clear and
compelling rationale for an alternative approach is present
1. Encourage appropriate use of antimicrobials for CDI treatment and for non-CDI
treatment through the implementation of an antimicrobial stewardship program. (M)
2. Implement diagnostic stewardship practices for ensuring appropriate use and
interpretation of C. difficile testing. (L)
a. Hospital infection prevention and control programs should work with their clinical
microbiolog y laboratory to develop pre-agreed criteria for C. difficile testing,
particularly if nucleic acid amplification tests (NAATs) are used as standalone tests
or as part of a multi-step testing algorithm.
b. At minimum, C. difficile testing should be avoided in patients without clinically
significant diarrhea, in those who have been tested in the prior 7 days, and in
children aged <1 year.
c. Bedside nurses and healthcare personnel (HCP) who order tests should receive
education about appropriate use and interpretation of C. difficile testing.
d. If feasible, use the electronic medical record system to provide computerized
provider order entry support and/or monitoring for clinical testing criteria.
3. Use contact precautions for infected patients, single-patient room preferred. (L for
hand hygiene; M for gloves; L for gowns; L for single-patient room)
a. Perform hand hygiene based on CDC or World Health Organization (WHO)
guidelines before and after entering the room (i.e., immediately before donning and
after removing personal protective equipment).
b. Place patients with CDI on contact precautions to help reduce patient-to-patient
transmission.
c. Cohorting of patients with CDI is acceptable when single private rooms are not
available.
d. Ensure that adequate supplies for contact precautions are readily available.
e. Follow appropriate criteria for discontinuing contact precautions.
4. Adequately clean and disinfect equipment and the environment of patients with CDI.
(L for equipment; L for environment)
a. C. difficile spores contaminate the environment in which patients are housed and
the equipment used to care for them.
b. Contaminated surfaces and equipment are potential reservoirs for transmission of
C. difficile.
c. Develop and implement protocols for disinfection of equipment and the
environment.
d. Dedicate noncritical patient care items, such as blood pressure cuffs, stethoscopes,
and thermometers, to a single patient with C. difficile.
