Household Hygiene Advice for People with Clostridioides difficile Infection

This thesis explored the household hygiene advice necessary for people who have Clostridioides difficile infection (CDI) to reduce the risk of reinfection or transmission to household contacts. This thesis includes a survey and an environmental scan of Ontario hospitals to understand the information that hospitals provide to CDI patients about household hygiene. It also includes a scoping review that describes the existing literature on the role of the household environment in CDI transmission. Semi-structured interviews with people who have had CDI were conducted to gather details on their household hygiene knowledge and practice. It was discovered that the information on household hygiene provided in existing guidelines and hospital information sheets is inconsistent, unclear and likely ineffective. This stems from the lack of conclusive research into the risk of transmission of C. difficile in the household environment. Ontario Infection Control Professionals (ICPs) surveyed generally agreed that the household environment is a concern, but they were not sure what advice to give patients. Recall of patients about household hygiene teaching is poor. Household hygiene practices and feces were perceived by patients as embarrassing topics to discuss, and people with CDI were anxious about the possibility of reinfection or transmitting the infection to others. The results of this research are important as they indicate that the current state of patient education on household hygiene is insufficient. Targeted hygiene procedures for household hygiene could reduce the risk of recurrence for people with CDI and the risk of asymptomatic colonization for household members. A clearly articulated household hygiene practice could also be effective against other pathogens that can persist in the household environment such as Norovirus. Developing, implementing and supporting people to implement a more thoughtful process for household hygiene could be impactful in reducing morbidity and anxiety related to transmission of CDI and other pathogens in the home.