Whereas vegetative cells die off rapidly in the environment on dry surfaces (Jump et al. 2011), and vegetative cell concentrations may be an order of magnitude more abundant (Jump et al. Spore concentrations in symptomatic CDI patients may be from 10 4 to 10 6 spores per gram of stool (Kim et al. difficile bacterial endospores (spores) and vegetative cells are shed in stool. 2011).ĬDI patients experience multiple episodes of watery diarrhea each day, and both C. 2012), was responsible for an estimated $4.8 billion in excess healthcare costs for acute care facilities in 2008 (Dubberke and Olsen 2012), and has become one of the most common healthcare-acquired infections in the USA (Magill et al. CDI is the leading cause of gastroenteritis-associated death, causing 14,000 deaths in 2007 alone (Hall et al. Of these nearly half million cases, an estimated 293,300 were healthcare-associated with 107,600 hospital onset, 104,400 nursing home onset, and 81,300 post-outpatient care onset. Healthcare-acquired Clostridium difficile infection (CDI) is a significant burden to US healthcare facilities and their patients, with an estimated 453,000 incident CDI and 29,000 deaths in 2011 (Lessa et al. difficile spores present or fail to detect airborne spores. Impinger air sampling could significantly underestimate the actual number of airborne C. Slit-to-agar air sampling may underestimate the number of airborne spores present. Filter air sampling provided the greatest collection of airborne spores. This study is the first to compare the efficiencies of commonly used bioaerosol sampling methods to collect airborne C. Impingers failed to maintain culturability of C. Efficiencies of the impingers were similar and were low (mean 4.13%, 95% CI 2.27–5.99%). Relative efficiency for the 47-mm MCE filter cartridge was higher than the slit-to-agar impactor (mean 136.6%, 95% CI 124.7–148.5%). The slit-to-agar impactor, successfully used in previous studies to collect airborne spores, served as the reference method.
Side-by-side air samples were drawn from the enclosure. difficile spores were nebulized into an enclosure contained in a biological safety cabinet. Air samplers evaluated in this study were the AirTrace slit-to-agar impactor, AGI-30 impinger, SKC BioSampler impinger, and a 47-mm mixed cellulose ester (MCE) filter cassette. This study determined the relative efficiency of commonly used bioaerosol air sampling methods when characterizing airborne C. This study compared the methods in the collection of C. Once airborne, spores have the potential for transport on air currents to other areas. difficile) endospores (spores) in healthcare environments is documented in multiple studies. The airborne dissemination of Clostridium difficile ( C.