fecal incontinence, diarrhea defined as 3 or more unformed stools within a 24 hour period, medications, and mobility subscale score from the Braden score. Patients were seen at the time of their clinic visit in the examination room. To determine the frequency of carriage of C. difficile, perirectal swabs were collected and cultured for toxigenic C. 220551-92-8 customer reviews difficile as previously described. To 681159-27-3 assess skin contamination, an investigator donned sterile gloves, moistened the fingertips of the gloves using sterile water, imprinted the gloves onto the patient��s abdomen, chest, arm, and hand in a standardized manner simulating a physical examination, and then imprinted the gloved hand onto a pre-reduced C. difficile Brucella agar selective plate. A separate sterile glove was used to contact each culture site. To assess environmental shedding, high-touch surfaces including the examination chair arm rest, examination table, and telephone and computer keyboard in the physician work area were cultured similarly using gloved hand prints both before the provider entered the room but after collection of perirectal and skin cultures and again after completion of the outpatient visit. Patients with positive environmental cultures prior to the provider interaction were excluded from the analysis. The CDBA plates were transferred within 15 min to an anaerobic chamber and cultures were processed as previously described. All isolates were tested for in vitro toxin production with use of C. difficileTox A/B II. Isolates that did not produce toxin were excluded from the analysis. For a subset of patients, PCR ribotyping was performed to compare perirectal, skin, and environmental isolates as previously described. To further assess C. difficile contamination in outpatient settings, we performed a point-prevalence culture survey of high-touch surfaces in 57 examination rooms in 7 outpatient clinics and 27 examination rooms in 3 Emergency Departments in Northeast Ohio. The freestanding outpatient clinics provided general medical care. The hospital-based clinics provided general medical and medical and surgical subspecialty care. Premoistened swabs were applied to 3 separate sites, includin
