UV-visible Marker Confirms Environmental Persistence of Clostridium Difficile Spores in Toilets



UV-visible marker confirms that environmental persistence of Clostridium difficile spores in toilets of patients with C. difficile-associated diarrhea is associated with lack of compliance with cleaning protocol.



An ultraviolet visible marker (UVM) was used to assess the cleaning compliance of housekeeping staff for toilets in a tertiary healthcare setting.



The UVM was applied to the toilets of patients who were on isolation precautions due to Clostridium difficile-associated diarrhea (CDAD) as well as for patients who were not on isolation precautions. Cleaning was visually scored using a numeric system where 0, 1, 2, and 3 represented; no, light, moderate or heavy residual UVM. Rodac plates containing CDMN selective agar were used to test for the presence of C. difficile on the surfaces of patient’s toilets.



Despite twice daily cleaning for the toilets of patients who were on CDAD isolation precautions, the average cleaning score was 1.23 whereas the average cleaning score for toilets of patients not on isolation precautions was 0.9. Even with optimal cleaning (UVM score of 0) C. difficile was detected from 33% of the samples taken from toilets of patients with CDAD (4% detection in toilet samples from patients who had diarrhea not due to CDAD).



Our data demonstrated the value of UVM for monitoring the compliance of housekeeping staff with the facility’s toilet cleaning protocol. In addition to providing good physical cleaning action, agents with some sporicidal activity against C. difficile may be needed to effectively reduce the environmental reservoir.




Michelle J Alfa – 1,2,3*

Christine Dueck – 1

Nancy Olson – 3 

Pat DeGagne – 2

Selena Papetti – 3

Alana Wald – 2

Evelyn Lo – 1 

Godfrey Harding – 1,2

* Corresponding author: Michelle J Alfa [email protected]

Author Affiliations

1 – Department of Medical Microbiology, University of Manitoba, Winnipeg, Manitoba, Canada

2 – Diagnostic Services of Manitoba, Microbiology Discipline, St. Boniface General Hospital site, Winnipeg, Manitoba, Canada

3 – Microbiology laboratory, St. Boniface Research Centre, Winnipeg, Manitoba, Canada

BMC Infectious Diseases 2008, 8:64 doi:10.1186/1471-2334-8-64




© 2008 Alfa et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.