Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Medicine Department, School of Medicine, Universidad Complutense de Madrid (UCM), Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Department of Clinical Microbiology and Infectious Diseases, Hospital General Universitario Gregorio Marañón, Madrid, Spain; Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
Clin Microbiol Infect. 2020 Mar;26(3):340-344. doi: 10.1016/j.cmi.2019.06.027. Epub 2019 Jul 5.
Clostridioides difficile infection has traditionally been considered to be transmitted predominantly within health-care settings. It is not recognized as a pathogen that presents a risk of laboratory acquisition. Data on laboratory contamination and acquisition by laboratory personnel are lacking. Our objective was to assess environmental contamination by C. difficile and its potential for transmission in a clinical microbiology laboratory.
Laboratory surfaces were screened for C. difficile. Samples were taken in areas that handle C. difficile isolates (high-exposure (HE) areas), areas adjacent to HE areas or those processing faecal samples (medium-exposure (ME) areas), and areas that do not process faecal samples or C. difficile isolates (low-exposure (LE) areas). We examined C. difficile carriage (hands/rectal samples) of laboratory workers.
A total of 140 environmental samples were collected from two HE areas (n = 56), two ME areas (n = 56) and two LE areas (n = 28). Overall, 37.8% (37/98) of surfaces were contaminated with C. difficile, and 17.3% (17/98) with toxigenic C. difficile (TCD). HE areas were significantly more contaminated with TCD than LE areas (38.1% (16/42) versus 0.0% (0/14), p 0.005) and ME areas (38.1% (16/42) versus 2.4% (1/42), p <0.001). Hands were colonized with TCD in 11.8% (4/34) of cases. We found no rectal carriage of C. difficile.
We found a significant proportion of laboratory surfaces to be contaminated with toxigenic C. difficile, as well as hand colonization of laboratory personnel. We recommend specific control measures for high-risk areas and laboratory personnel working in these areas.
艰难梭菌感染传统上被认为主要在医疗机构内传播。它不被认为是具有实验室获得风险的病原体。缺乏关于实验室污染和实验室人员获得的相关数据。我们的目的是评估临床微生物学实验室中艰难梭菌的环境污染及其传播的可能性。
对实验室表面进行艰难梭菌筛查。在处理艰难梭菌分离株的区域（高暴露（HE）区域）、紧邻 HE 区域或处理粪便样本的区域（中暴露（ME）区域）以及不处理粪便样本或艰难梭菌分离株的区域（低暴露（LE）区域）采集样本。我们检查了实验室工作人员的艰难梭菌携带情况（手部/直肠样本）。
从两个 HE 区域（n=56）、两个 ME 区域（n=56）和两个 LE 区域（n=28）共采集了 140 个环境样本。总体而言，98 个表面中有 37.8%（37/98）受到艰难梭菌污染，17.3%（17/98）受到产毒艰难梭菌（TCD）污染。HE 区域明显比 LE 区域（38.1%（16/42）与 0.0%（0/14），p<0.005）和 ME 区域（38.1%（16/42）与 2.4%（1/42），p<0.001）更易受到 TCD 污染。在 4/34 例（11.8%）中发现手部携带 TCD。我们未发现直肠携带艰难梭菌。
我们发现实验室表面有相当大比例受到产毒艰难梭菌污染，并且实验室人员手部也有携带。我们建议对高风险区域和在这些区域工作的实验室人员采取具体的控制措施。
