# Understanding and preventing Clostridium difficile transmission from asymptomatically colonized patients

> **NIH AHRQ R01** · UNIVERSITY OF MARYLAND BALTIMORE · 2020 · $415,791

## Abstract

Clostridium difficile is the most common cause of healthcare-associated infections (HAIs) in the US, causing at
least 450,000 infections and 29,000 associated deaths per year. Current C. difficile infection (CDI) prevention
strategies have not decreased CDI. These strategies focus on preventing C. difficile transmission only from
patients with symptomatic CDI, and ignore the much more common asymptomatic C. difficile carriers.
Asymptomatic C. difficile carriers contaminate the hospital environment, transfer C. difficile spores to
healthcare workers hands, and introduce strains associated with subsequent CDI cases. In addition, recent
studies suggest at least 30% to 50% of new CDI cases are a result of transmission from asymptomatic C.
difficile carriers. However, the potential impact of interventions directed at asymptomatic C. difficile carriers has
not been adequately studied. One such strategy to prevent C. difficile transmission among hospitalized
patients would be the use of gowns and gloves (contact precautions) for patients asymptomatically colonized
with C. difficile. Identifying reductions in C. difficile transmission from asymptomatic carriers with contact
precautions would change the paradigm of C. difficile prevention. We hypothesize that patients
asymptomatically colonized with C. difficile are important for transmission in the hospital, and use of contact
precautions for these patients will lead to decrease in patient-to-patient transmission of C. difficile. The study
design is a retrospective analysis of stored specimens that were obtained from a 20 hospital cluster-
randomized trial. Aim 1 will assess whether wearing gloves and gowns for all patient contact decreases
acquisition of and infection with C. difficile. Aim 2 will assess the relative importance of colonization pressure
with C. difficile on C. difficile transmission, and Aim 3 will determine if the NAP-1/027 strain is more
transmissible than other strains. This innovative approach will develop the first randomized trial level data to
guide C. difficile infection prevention and will inform science on the importance of individuals asymptomatically
colonized with NAP-1/027 or other C. difficile strains. This proposal will go beyond the original cluster trial in
Aim 1 to assess key questions of colonization pressure, contact precautions and NAP-1/027 on C. difficile
transmission.

## Key facts

- **NIH application ID:** 9926774
- **Project number:** 5R01HS025456-04
- **Recipient organization:** UNIVERSITY OF MARYLAND BALTIMORE
- **Principal Investigator:** Daniel J Morgan
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** AHRQ
- **Fiscal year:** 2020
- **Award amount:** $415,791
- **Award type:** 5
- **Project period:** 2017-08-01 → 2022-05-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/9926774

## Citation

> US National Institutes of Health, RePORTER application 9926774, Understanding and preventing Clostridium difficile transmission from asymptomatically colonized patients (5R01HS025456-04). Retrieved via AI Analytics 2026-05-28 from https://api.ai-analytics.org/grant/nih/9926774. Licensed CC0.

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