7
S, strong ; W, weak; C, conditional; H, high; M, moderate; L, low; VL, very low quality of evidence;
GP, good practice; NR, no recommendation
➤ Terminal room cleaning with a sporicidal agent should be considered
in conjunction with other measures to prevent CDI during endemic
high rates or outbreaks or if there is evidence of repeated cases of
CDI in the same room (W-L).
➤ Incorporate measures of cleaning effectiveness to ensure quality of
environmental cleaning (GP).
➤ There are limited data at this time to recommend use of automated,
terminal disinfection using a sporicidal method for CDI prevention
(NR).
➤ Daily cleaning with a sporicidal agent should be considered in
conjunction with other measures to prevent CDI during outbreaks
or in hyperendemic (sustained high rates) settings, or if there is
evidence of repeated cases of CDI in the same room (W-L).
➤ There are insufficient data to recommend screening for asymptomatic
carriage and placing asymptomatic carriers on contact precautions
(NR).
➤ Minimize the frequency and duration of high-risk antibiotic therapy
and the number of antibiotic agents prescribed, to reduce CDI risk
(S-M).
➤ Implement an antibiotic stewardship program (GP).
➤ Antibiotics to be targeted should be based on the local epidemiology
and the C. difficile strains present. Restriction of fluoroquinolones,
clindamycin and cephalosporins (except for surgical antibiotic
prophylaxis) should be considered (S-M).
➤ Although there is an epidemiologic association between proton pump
inhibitors (PPIs) use and CDI, and unnecessary PPIs should always
be discontinued, there is insufficient evidence for discontinuation of
PPIs as a measure for preventing CDI (NR).
➤ There are insufficient data at this time to recommend administration
of probiotics for primary prevention of CDI outside of clinical trials
(NR).
