Identifying Contact Time Required for Secondary Transmission of Clostridioides difficile Infections by Using Real-Time Locating System

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Authors: Min Hyung Kim ; Jaewoong Kim ; Heejin Ra ; Sooyeon Jeong ; Yoon Soo Park ; Dongju Won ; Hyukmin Lee ; Heejung Kim

MeSH: Adult ; Aged ; Clostridioides difficile* / genetics ; Clostridioides difficile* / isolation & purification ; Clostridium Infections* / epidemiology ; Clostridium Infections* / microbiology ; Clostridium Infections* / transmission ; Contact Tracing ; Cross Infection / epidemiology ; Cross Infection / microbiology ; Cross Infection / transmission ; Female ; Humans ; Male ; Middle Aged ; Republic of Korea / epidemiology ; Retrospective Studies ; Time Factors

Keywords: Clostridioides difficile ; Clostridioides difficile infection ; South Korea ; bacteria ; enteric infections ; horizontal transmission of infectious diseases ; hospital-acquired infections ; patient isolation ; real-time locating system ; secondary transmission

Abstract: Considering patient room shortages and prevalence of other communicable diseases, reassessing the isolation of patients with Clostridioides difficile infection (CDI) is imperative. We conducted a retrospective study to investigate the secondary CDI transmission rate in a hospital in South Korea, where patients with CDI were not isolated. Using data from a real-time locating system and electronic medical records, we investigated patients who had both direct and indirect contact with CDI index patients. The primary outcome was secondary CDI transmission, identified by whole-genome sequencing. Among 909 direct and 2,711 indirect contact cases, 2 instances of secondary transmission were observed (2 [0.05%] of 3,620 cases), 1 transmission via direct contact and 1 via environmental sources. A low level of direct contact (113 minutes) was required for secondary CDI transmission. Our findings support the adoption of exhaustive standard preventive measures, including environmental decontamination, rather than contact isolation of CDI patients in nonoutbreak settings.