Clostridioides difficile (CD) infection is one of the main gastrointestinal complications related to healthcare-associated infections (HAIs), with great clinical impact. In oncology patients, it is even more relevant, since these patients are more susceptible to severe forms with worse clinical outcomes, which can lead to delays in oncology treatment and other impacts such as blocking beds for isolation, greater use of personal protective equipment, restriction of visits, difficulties in bed management, and risk of transmission to other patients. This report aims to describe the impact of environmental and hand hygiene measures to control HAIs due to CD. Retrospective descriptive, quasi-experimental (pre- and post-intervention) study in an exclusive pediatric oncology hospital, from April 2024 to May 2025, with data extracted from the active epidemiological surveillance system of the HICC. Incidence rates of HAIs due to CD (per 1000 patient-days) were compared before and after the intervention. In the period from April to September (pre-intervention), a high rate of HAIs due to CD was observed, with an average incidence of 4.7 cases/1000 patient-days, highlighting August 2024 (4 cases; 14.7 cases/1000 patient-days). After identifying the increase, in September trainings were conducted on environmental cleaning, guidance on contact precautions, hand hygiene with soap and water, and the surface cleaning product for rooms of suspected and confirmed cases was changed to a quaternary ammonium compound with chlorine dioxide. After the intervention, there was a drop in the number of cases in the following months, resulting in an average rate of 2.8 cases/1000 patient-days (October/2024 to May/2025). In January, February, and May 2025 no HAIs due to CD were observed. Eliminating CD is challenging because transmission occurs through contact and its spores can persist for long periods in the environment, being resistant to common hospital disinfectants and even to hand hygiene with alcohol gel. Environmental cleaning and decontamination is the most economical strategy to prevent spread, colonization, and infection by CD. The measures implemented for environmental control of CD appear to be associated with a reduction in HAI cases caused by this agent.
Hoshino et al. (Sun,) studied this question.