It would be prudent to
bear in mind, however, that a negative result for C. difficile does not necessarily mean that the patient can be removed from single room isolation, since the symptoms selleck screening library could be due to another infectious cause such as norovirus. Ideally the patient would be tested for a range of infectious agents to be confident that they do not pose a risk of cross transmission before de-isolating . UK and European guidance recommends testing for CDI using a two-step algorithm with either GDH or a molecular test as a first stage and confirming any positives with a toxin enzyme immunoassays (EIA) [21, 22]. This study was conceived and carried out before this guidance was published and there is still debate about the clinical interpretation of PCR positive tests in diarrheal patients . Given the current testing guidelines endorsed by Public Health, England and European Society of Clinical Microbiology and Infectious Diseases (ESCMID), perhaps there could be additional value of this assay in screening newly admitted patients for colonization. Asymptomatic carriage is widespread
amongst hospital inpatients  and potential transmission from this group has already Syk inhibitor been demonstrated . Peri-rectal swabs could provide a more convenient and acceptable sample type for screening patients . The practice of screening for carriage is not widely practiced, however, modeling has shown that this approach may be cost effective . Financial costs were not evaluated in this study. However, when deciding to implement a POCT, it is important to consider the often hidden costs of support from a local
accredited laboratory, and costs of training and maintenance; these should be measured in any future evaluation. Conclusion This study demonstrates that POCT using the GeneXpert® Nintedanib (BIBF 1120) system is feasible and acceptable to nursing staff and technicians working within the two extremes of these hospital-based settings. The assay has already been used in a variety of settings including in resource poor countries [28, 29]. These types of tests are becoming increasingly more common and it is important that they are assessed in the environment for which they are intended with high-quality clinical utility studies, which also evaluate cost effectiveness. Acknowledgments We are grateful to the staff of the ICUs and older persons’ wards who contributed to the study. This work was funded with a Grant from The Technology Strategy Board (Swindon UK) and by the National Institute for Health Research (NIHR) comprehensive Biomedical Research Centre award to Guy’s and St Thomas’ NHS Foundation Trust in partnership with King’s College London. Article processing charges were funded by Cepheid check details Europe (Maurens-Scopont, France).