CLOSTRIDIUM DIFFICILE: KEEPING YOUR PATIENTS SAFEOre Ezeigbo, RN, BSNGraduate StudentNotre Dame of Maryland University

C. DIFF: DID YOU KNOW? C. diff…

Is a spore-producing bacteria

Causes severe diarrhea in some people

Carriers can have C. diff and not be sick

Most people get sick after taking antibiotics

C. diff can be found in… Air Water Soil Human and animal

feces Processed meats

More and more people are getting C. diff before they enter the hospital

WHO IS AT RISK? Elderly population People with

weakened immune systems

People who have been taking antibiotics

HOW DOES C. DIFF WORK? C. diff is passed in feces C. diff produces spores that can live outside

of the body for weeks or months! Once inside the body, C. diff produces toxins

that attack the intestinal lining This causes intestinal inflammation and leads

to watery diarrhea

C. DIFF CAN BE SPREAD BY… Person to person

Most common Bed linen Bed rails Bedside tables Bathroom fixtures Medical equipment

Toilets Sinks Stethoscopes Thermometers Telephones Remote controls

SYMPTOMS OF A MILD TO MODERATE INFECTION Watery diarrhea for 2 to 3 days Fever Loss of appetite Nausea Abdominal pain and tenderness

SYMPTOMS OF A SEVERE INFECTION Watery diarrhea 10

to 15 times a day Severe abdominal

cramping Fever Blood or pus in stool Dehydration

Nausea Loss of appetite Weight loss Swollen abdomen Kidney failure Increased WBCs

SEVERE INFECTIONS CAN LEAD TO… Dehydration Kidney failure Colitis

Inflamed colon Pseudomembranous

colitis Raw, bleeding, pus-

producing tissue

Toxic megacolon Colon is unable to

expel gas and stool Bowel perforation

A hole in the large intestine

Death

HOW IS C. DIFF DIAGNOSED? At our hospital, we use the polymerase chain

reaction This is a molecular test that rapidly detects the

C. diff toxin B gene in a stool sample It is highly accurate It is fast

HOW IS C. DIFF TREATED? Antibiotics are used

to keep the C. diff from growing Metronidazole

(Flagyl) Vancomycin

(Vancocin) Surgery

To remove the infected part of the intestines

For recurrent cases… Fecal microbiota

transplant (FMT) Placing another

person’s stool in the infected person’s colon

Experimental Early studies show

promising results Probiotics

Bacteria and yeast which help restore a healthy intestinal balance

PROTECTING OUR PATIENTS Hand hygiene

Soap and warm water hand-washing BEFORE and AFTER every patient contact

Visitors should wash their hands with soap and warm water after leaving the room or using the bathroom

Thorough cleaning All surfaces should be disinfected with chlorine

bleach C. diff spores can survive routine cleaning

products

PROTECTING OUR PATIENTS: CONTACT PRECAUTIONS• Place in a private room

or a room with another patient with C. diff

• Wear a gown and gloves while in the room Staff and visitors Gowns must be tied

using both ties to cover your clothing

• Use a disposable blood pressure cuff

Store on the upper bed rail when not in use

Use a disposable thermometer Located in the top drawer

of the isolation cart Call the warehouse for

more thermometers Leave on bedside table

when not in use Use a disposable

stethoscope Clean before and after

use Leave hanging on IV pole

when not in use

REFERENCES Centers for Disease Control and Prevention. (n.d.). FAQs about

Clostridium difficile. In CDC.gov (official website of Centers for Disease Control and Prevention). Retrieved from http://www.cdc.gov/HAI/pdfs/cdiff/Cdiff_tagged.pdf

Mayo Clinic Staff. (2013). C. difficile. In Mayoclinic.com (official website of the Mayo Clinic). Retrieved from http://www.mayoclinic.com/print/c-difficile/DS00736/METHOD=print&DSECTION=all