Skip to main content

Main menu

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
  • Other Publications
    • Ochsner Journal Blog

User menu

  • My alerts
  • Log in

Search

  • Advanced search
Ochsner Journal
  • Other Publications
    • Ochsner Journal Blog
  • My alerts
  • Log in
Ochsner Journal

Advanced Search

  • Home
  • Content
    • Current
    • Ahead of print
    • Archive
  • Info for
    • Authors
    • Reviewers
  • About Us
    • About the Ochsner Journal
    • Editorial Board
  • More
    • Alerts
    • Feedback
LetterLetters to the Editor

Letters to the Editor

Matthew Clark
Ochsner Journal June 2014, 14 (2) 300;
Matthew Clark
The University of Queensland School of Medicine, Ochsner Clinical School, New Orleans, LA,
BS
  • Find this author on Google Scholar
  • Find this author on PubMed
  • Search for this author on this site
  • For correspondence: ven_maclark@ochsner.org
  • Article
  • References
  • Info & Metrics
  • PDF
Loading

To the Editor:

The association between hospitals and the acquisition of Clostridium difficile infection (CDI) has been extensively reported, with up to 15% of patients becoming infected during their hospital stay.1 More recently, however, Chitnis et al reported a strong association between CDI and even low-level healthcare exposure.2 They found that 40.7% of patients with community-acquired CDI had at least low-level healthcare exposure, defined as “a visit to a dentist, physician, or other outpatient clinic” in the past 12 months.2 Comparatively, 18% of patients with community-acquired CDI had no healthcare exposure whatsoever. Thus, exposure even to nonhospital healthcare settings increases the risk of CDI, with greater levels of care leading to higher infection rates.2

Previous studies have shown that 2.5%-15.3% of healthy individuals are carriers of C. difficile3,4 and that healthcare workers do not have an increased rate of colonization compared to the general population.4,5 Studies have shown that up to 59% of healthcare workers have skin carriage of C. difficile after direct contact with an infected patient, but hand washing after patient care greatly reduces carriage rates.6 Because hand washing has been proven to be superior to alcohol-based rubs in reducing C. difficile transmission, most healthcare workers are aware that they are required to wash their hands after contact with infected patients.6 This knowledge may help explain why healthcare workers do not have higher colonization rates than the general population even though they spend more time in healthcare settings. If healthcare workers are not an identifiable source of infection transmission, perhaps the healthcare settings themselves are a cause of increased infection transmission.

Although environments can serve as sources of bacterial transmission, most studies quantifying environmental C. difficile spores have focused on hospital settings and not outpatient clinics. Additionally, research into decontamination techniques in hospital settings has shown some methods to be more promising than others. Because Chitnis et al found a correlation between increased level of care and increased CDI, further investigation into the prevalence of C. difficile spores in low-level healthcare settings, such as clinics, is necessary. Increased identification of sources of transmission in nonhospital settings and better methods of decontamination may aid in the reduction of community-acquired CDI rates in the future.

  • © Academic Division of Ochsner Clinic Foundation

REFERENCES

  1. ↵
    1. Samore MH,
    2. DeGirolami PC,
    3. Tlucko A,
    4. Lichtenberg DA,
    5. Melvin ZA,
    6. Karchmer AW
    (2, 1994) Clostridium difficile colonization and diarrhea at a tertiary care hospital. Clin Infect Dis 18(2):181–187, pmid:8161624.
    OpenUrlCrossRefPubMed
  2. ↵
    1. Chitnis AS,
    2. Holzbauer SM,
    3. Belflower RM,
    4. et al.
    (6 22, 2013) Epidemiology of community-associated Clostridium difficile infection, 2009 through 2011. JAMA Intern Med 173(14):1359–1367, pmid:23780507.
    OpenUrlCrossRefPubMed
  3. ↵
    1. Ozaki E,
    2. Kato H,
    3. Kita H,
    4. et al.
    (2, 2004) Clostridium difficile colonization in healthy adults: transient colonization and correlation with enterococcal colonization. J Med Microbiol 53((Pt 2)):167–172, pmid:14729940.
    OpenUrlCrossRefPubMed
  4. ↵
    1. Kato H,
    2. Kita H,
    3. Karasawa T,
    4. et al.
    (8, 2001) Colonisation and transmission of Clostridium difficile in healthy individuals examined by PCR ribotyping and pulsed-field gel electrophoresis. J Med Microbiol 50(8):720–727, pmid:11478676.
    OpenUrlCrossRefPubMed
  5. ↵
    1. van Nood E,
    2. van Dijk K,
    3. Hegeman Z,
    4. Speelman P,
    5. Visser CE
    (9, 2009) Asymptomatic carriage of Clostridium difficile among HCWs: Do we disregard the doctor? Infect Control Hosp Epidemiol 30(9):924–925, pmid:19653823.
    OpenUrlCrossRefPubMed
  6. ↵
    1. McFarland LV,
    2. Mulligan ME,
    3. Kwok RY,
    4. Stamm WE
    (1 26, 1989) Nosocomial acquisition of Clostridium difficile infection. N Engl J Med 320(4):204–210, pmid:2911306.
    OpenUrlCrossRefPubMed
PreviousNext
Back to top

In this issue

Ochsner Journal
Vol. 14, Issue 2
Jun 2014
  • Table of Contents
  • Index by author
Print
Download PDF
Email Article

Thank you for your interest in spreading the word on Ochsner Journal.

NOTE: We only request your email address so that the person you are recommending the page to knows that you wanted them to see it, and that it is not junk mail. We do not capture any email address.

Enter multiple addresses on separate lines or separate them with commas.
Letters to the Editor
(Your Name) has sent you a message from Ochsner Journal
(Your Name) thought you would like to see the Ochsner Journal web site.
CAPTCHA
This question is for testing whether or not you are a human visitor and to prevent automated spam submissions.
Citation Tools
Letters to the Editor
Matthew Clark
Ochsner Journal Jun 2014, 14 (2) 300;

Citation Manager Formats

  • BibTeX
  • Bookends
  • EasyBib
  • EndNote (tagged)
  • EndNote 8 (xml)
  • Medlars
  • Mendeley
  • Papers
  • RefWorks Tagged
  • Ref Manager
  • RIS
  • Zotero
Share
Letters to the Editor
Matthew Clark
Ochsner Journal Jun 2014, 14 (2) 300;
del.icio.us logo Twitter logo Facebook logo Mendeley logo
  • Tweet Widget
  • Facebook Like
  • Google Plus One

Jump to section

  • Article
    • REFERENCES
  • References
  • Info & Metrics
  • PDF

Cited By...

  • Recent Publications by Ochsner Authors
  • Google Scholar

More in this TOC Section

  • Reply to “Comment on ‘Pneumocystis jirovecii Pneumonia in Patients Treated for Solid Organ Malignancy’ ”
  • Comment on “Pneumocystis jirovecii Pneumonia in Patients Treated for Solid Organ Malignancy”
  • Reply to “The SARS-COV Pandemic Does Not Absolve From Solid Medical Trade”
Show more LETTERS TO THE EDITOR

Similar Articles

Ochsner Journal Blog

Current Post

Be Careful Where You Publish

Our Content

  • Home
  • Current Issue
  • Ahead of Print
  • Archive
  • Featured Contributors
  • Ochsner Journal Blog
  • Archive at PubMed Central

Information & Forms

  • Instructions for Authors
  • Instructions for Reviewers
  • Submission Checklist
  • FAQ
  • License for Publishing-Author Attestation
  • Patient Consent Form
  • Submit a Manuscript

Services & Contacts

  • Permissions
  • Sign up for our electronic table of contents
  • Feedback Form
  • Contact Us

About Us

  • Editorial Board
  • About the Ochsner Journal
  • Ochsner Health
  • University of Queensland-Ochsner Clinical School
  • Alliance of Independent Academic Medical Centers

© 2025 Ochsner Clinic Foundation

Powered by HighWire