I asked Mayfield why providers might not use bleach.
"Some people don't want to use bleach because it's corrosive. It can damage equipment, furniture, clothing, uniforms, and it may be irritating to patients, and that's why there's reluctance to use it automatically," she explains.
And bleach isn't necessarily the solution. "Sodium hydroclorite is only as good as the person doing the cleaning," she says.
Another survey eye-opener is the wide variation in providers' use of contact precautions for their C. diff patients. One in four respondents said they keep patients on contact precautions until after drug treatment has started and the patient has had no diarrhea for 48 hours.
But 42% activate it for the entire duration of hospitalization or until discharge, 9% until after treatment has started and there has been no diarrhea for 72 hours, and 24% gave several other answers.
There is some hope that a patient cure to C. diff may be found, even if environmental eradication of spores proves more challenging. Mayfield says that fecal transplants so far tried in just a very few patients, have had "remarkable success." But patients are only eligible for that procedure if they have failed other efforts other drug regimens, by which time it may be closer to a last resort.
"There's a lot of interest in the biology of C. diff," Mayfield says. "But I can't say that in five years there will be anything at the patient level, ready to administer and proven efficacious, that does what it's supposed to do without killing people."
So healthcare settings are going to have to step up their diligence, she says. "This infection requires commitment in terms of dollars and personnel to explore new technologies and engineering controls." Newer technologies like UV radiation lights to kill spores or hydrogen peroxide vapor should be tried, but that costs money too, she says.