Brief report Hospital Clostridium difficile outbreak linked to laundry machine malfunction Shelini Sooklal MD *, Ayesha Khan MD, Saman Kannangara MD Department of Internal Medicine, Easton Hospital, Easton, PA Key Words: Nosocomial Feces Floor Mop Stool Clostridium difficile is a gram-positive, spore-forming anaerobic bacillus that is associated with diarrheal disease. C difficile is shed in the feces of affected individuals and its spores can survive on surfaces for prolonged periods of time. These spores can contaminate a hospital environment by spread through health care workers and suboptimal environmental cleaning practices. We report an outbreak of health care facility-onset C difficile infection that was eventually linked to contaminated mop pads after a laundry machine malfunction. Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. Clostridium difficile is a gram-positive, spore-forming anaerobic bacillus that is associated with diarrheal disease. C difficile infection (CDI) is a frequent nosocomial illness, and is an increasing problem in hospitals globally. C difficile has been identified as the pathologic agent in 10%-20% of cases of antibiotic-associated diarrhea, and has been implicated in as many as 50% of epidemic outbreaks. 1 CDI rates have also been rising: from 1996 to 2003 CDI rates per 100,000 population almost doubled in the United States. 2 Data from the Centers for Disease Control and Prevention show that the rate of the discharge diagnosis of C difficile infection increased from 31 cases per 100,000 persons per year in 1996 to 61 cases per 100,000 persons per year in 2003. 3 C difficile is shed in the feces of affected individuals and its spores can survive on surfaces for prolonged periods of time. The spores can contaminate a hospital environment and be spread by health care workers and suboptimal environmental cleaning practices. At an academic community hospital in Pennsylvania the infec- tion control team noted a disturbing trend during June 2013. The number of cases of health care facility-onset CDI had drastically increased. Health care facility-onset CDI was defined as a C difficile polymerase chain reaction-positive result of a stool specimen that was collected >3 calendar days after hospital admission. During the period January 2013-March 2013, 3 cases of health care facility- onset CDI were recorded. However, during the period April 2013- June 2013 (second quarter 2013), this number climbed to 11. The epidemic curve in Figure 1 demonstrates these findings by monthly incidence rate. The standardized infection ratio for second quarter 2013 was 1.67, with a standardized infection ratio P value of .05. This demonstrates that this increased CDI rate is statistically sig- nificant for the second quarter 2013. A multidisciplinary team was assembled to investigate this phenomenon. The number of hospital admissions between the 2 time periods in question was comparable and the case mix also was comparable. There was no significant difference in the community-onset CDI prevalence rate. Seasonal variation could not have accounted for the marked increase in cases because most cases of C difficile infection occur during the period November-January, coinciding Fig 1. Health care facility-onset cases of Clostridium difficile infection. * Address correspondence to Shelini Sooklal, MD, 250 S 21st St, Easton, PA 18045. E-mail address: shelinis@hotmail.com (S. Sooklal). Conflicts of interest: None to report. Contents lists available at ScienceDirect American Journal of Infection Control journal homepage: www.ajicjournal.org American Journal of Infection Control 0196-6553/$36.00 - Copyright Ó 2014 by the Association for Professionals in Infection Control and Epidemiology, Inc. Published by Elsevier Inc. All rights reserved. http://dx.doi.org/10.1016/j.ajic.2014.02.012 American Journal of Infection Control 42 (2014) 674-5