Stool Management Systems for Preventing Environmental Spread of Clostridium Difficile: A Comparative Trial

Emergence of a more virulent strain of Clostridium difficile (CD) is attributed to the increased prevalence of CD associated diarrhea seen in acute and critical care settings.¹ Because of the association of CD associated diarrhea and fecal incontinence, the risk for cross contamination is as high as 50%.² Existing evidence shows that stool management systems contain liquid stool and protect patients from secondary skin complications³, but research on their ability to prevent environmental spread is especially sparse. This study compared 2 stool management systems (devices 1 and 2) over a 30 day period in a controlled laboratory setting. Sixteen systems were filled with sterile loose stool inoculated with 10⁶ CFU/ ml CD (ATCC 42355); specially prepared culture media were used to detect CD contamination on various surfaces of the device and immediate environment. Containment bags were changed daily and the devices refilled with inoculated stool to more closely mimic use in the clinical setting. Analysis revealed that 79.2% of the anterior surface of the collection bags of device 1 group remained free from contamination versus 16.1% of device 2 bags (p<0.001). Comparison of the tubing/ hub interface revealed that 79.2% of device 1 group remained free from contamination versus 13.7% of interfaces in the device 2 group (p<0.001). Analysis of an absorbent pad placed under the device during daily changes found that 99.5% of device 1 remained uncontaminated versus 38.1% of pads placed under device 2 (p<0.001). Findings from this in vitro study demonstrate that stool management systems can limit or prevent environmental contamination of CD. Results also reveal significant differences in the 2 systems that we hypothesize are attributable to the area immediately adjacent to the tubing/ collection bag interface, the point where these systems are most often disconnected as collection bags become filled with fecal material.