Clostridium difficile infection is mainly a hospital-acquired infection. But now proving the adage true that bacteria are ubiquitous i.e., they can be found almost anywhere in the environment and not just within a healthcare setting, a new international study has shown the presence of C. difficile on shoe soles. C. difficile causes inflammation of the colon and severe diarrhea.

The new research was presented at the IDWeek, the joint annual meeting of the Infectious Diseases Society of America (IDSA), Society for Healthcare Epidemiology of America (SHEA), the HIV Medical Association (HIVMA), the Pediatric Infectious Diseases Society (PIDS) and the Society of Infectious Diseases Pharmacists (SIDP).

For the study, 11,986 environmental samples were collected from healthcare settings, public areas and shoe soles in the US and 11 other countries, including India, from 2014 to 2017. The samples were then tested for C. difficile positivity including their potential role in environmental transmission. Samples were grouped as being from outdoor environments (n = 2,992), private residences (n = 2,772), shoe soles (n = 1,420), public buildings (n = 1,104) or acute-care settings (n = 3,698).

Results showed 26% of samples from healthcare and non-healthcare sites to be positive for C. difficile strains. Shoe soles exhibited the highest positivity rate of 45% highlighting their role in transmission of the bacteria. The most common strains were FP310 (11%) found only in non-healthcare settings, F106 (15%) in both settings, and F014-020 (16%) in both settings.

These findings show that C. difficile is now not just a hospital-acquired pathogen, it is also present in the community evident by a recent rise in cases of community-acquired C. difficile infection. And, it is not just the hospitalised patients who are at risk of acquiring the infection, anybody in the community can be infected. Simple infection control measures such as hand hygiene and taking off your shoes can prevent the infection.

Dr Jinhee Jo, PharmD, a postdoctoral infectious disease fellow at the University of Houston and presenting author said, “They may introduce harmful bacteria into your bathroom or kitchen, which could make you sick. The next time you’re coming in from outside, take off your shoes before you enter a highly trafficked room and help reduce the risk of catching C. difficile.”

We take off our shoes before we enter any temple or religious place. It has also been customary for us to leave shoes outside before entering our homes. All our customs and traditions have a scientific rationale. Explaining this, Dr KK Aggarwal had written in his blog, “A house is also considered a temple, therefore, when you enter your house, you take off your shoes at the gate. Removing the shoes has both medical and spiritual reasoning. The medical reasoning is that  your shoes invariably carry infections and dirt from outside and can infect both the home and temple atmosphere.

Removing shoes also has a spiritual reasoning. In mythology shoes represent your perception towards dirt and dirt in mythology basically means mental dirt. removing your shoes means that before entering a temple, you take away your negative thoughts. Removing your shoes outside temple means a type of Pratyahara as mentioned in the Yoga Sutra Patanjali which is start of a new journey by keeping your negative thoughts out and then entering the temple premises with a positive state of mind.”

You can read the complete blog at https://blog.kkaggarwal.com/?p=4248

(Source: IDWeek News Release, 1^st October, 2021; Medpage Today, 3^rd October, 2021)