# An infection prevention dilemma: should we place patients with C. difficile colonization on contact precautions?

> **NIH AHRQ R01** · DUKE UNIVERSITY · 2024 · $500,000

## Abstract

Project Summary - Clostridioides difficile is a leading cause of infectious diarrhea and the most common cause
of healthcare-associated infection (HAIs) in the US, resulting in >450,000 infections and 29,000 deaths annually.
In fact, C. difficile was recently labeled as one of five “urgent threat” organisms by the CDC. Despite its
prevalence, C. difficile acquisition and transmission remain poorly understood. Recent changes in testing
strategies led to the surprising discovery that patients with C. difficile are more often colonized than infected.
Hospitals routinely place patients infected with C. difficile on “contact precautions” to prevent transmission.
However, this shifting epidemiology has led to an infection prevention dilemma: should patients with C. difficile
colonization be placed on contact precautions? The answer to this question is unknown. Recently published
infection prevention guidelines labeled this issue as “unresolved”. As a result, non-standardized practices are
being used. In our cohort of hospitals, 50% of hospitals place these patients on contact precautions and 50% do
not, suggesting that a substantial number of admitted patients are at potential risk of harm through either a)
unnecessary use of contact precautions OR b) through preventable exposure to C. difficile. The overall objective
of this proposal is to determine if contact precautions should be used in patients with C. difficile colonization.
First, we will determine the frequency, location, and amount of environmental C. difficile contamination among
300 patients with C. difficile colonization (150 with diarrhea and 150 without diarrhea) compared to 150 patients
with C. difficile infection (Specific Aim 1). Using these same rooms, we will then determine the frequency,
location, and amount of C. difficile contamination of 900 healthcare providers' (HCP) hands, HCP clothes, and
450 pieces of mobile, shared equipment following routine inpatient care of patients with C. difficile colonization
(Specific Aim 2). Finally, we will use ~1,500 C. difficile isolates from our unique C. difficile biorepository and
study activities in SA 1 and 2 to evaluate potential sources for C. difficile in-hospital transmission using molecular
epidemiology and whole genome sequencing (Specific Aim 3). This proposal will capitalize on the strengths of
the Duke Center for Antimicrobial Stewardship and Infection Prevention, including our collective expertise in
infection prevention and environmental contamination, our proven infrastructure for studies involving
environmental sampling, and our validated microbiological, statistical, and molecular epidemiological methods.
Our central hypothesis is that patients with C. difficile colonization contaminate their environment (surfaces, HCP,
and equipment) as frequently as patients with C. difficile infection and, as a result, are a source of in hospital
transmission. The proposed research is innovative because it represents a substantive departure...

## Key facts

- **NIH application ID:** 11021238
- **Project number:** 1R01HS030223-01
- **Recipient organization:** DUKE UNIVERSITY
- **Principal Investigator:** Deverick John Anderson
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2024
- **Award amount:** $500,000
- **Award type:** 1
- **Project period:** 2024-09-01 → 2028-06-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/11021238

## Citation

> US National Institutes of Health, RePORTER application 11021238, An infection prevention dilemma: should we place patients with C. difficile colonization on contact precautions? (1R01HS030223-01). Retrieved via AI Analytics 2026-06-03 from https://api.ai-analytics.org/grant/nih/11021238. Licensed CC0.

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