PURPOSE To prevent the transmission of C.difficile associated disease in the hospital
and outpatient settings.
* C.difficile has been a known cause of healthcare associated diarrhea for over 30 years. It can be acquired in both hospital and community settings. C.difficile exists in the environment and colonizes a small percentage of people without causing any symptoms.
* C.difficile produces spores that are resistant to most environmental cleaners and disinfectants with the exception of buffered sodium hypochlorite (bleach). Spread of C.difficile has been attributed to inadequate hand hygiene and environmental cleaning. Transmission prevention and ...view middle of the document...
Risk factors for C.difficile
Certain people/patients are at increased risk for acquiring CDAD. These risk factors include:
a) A history of antibiotic usage
b) Bowel surgery or other bowel integrity condition
a) Chemotherapy, radiation therapy
b) Prolonged hospitalization
Additional risk factors that predispose patients to develop more severe disease include:
a) Increased age
b) Serious underlying illness or debilitation
Diarrhea is defined as unformed or watery stools which conforms to a specimen container and occurs greater than or equal to 3 episodes in a 24-hour period. This pattern is unusual or different for the patient; and there is no other recognized etiology for diarrhea, such as laxative use, inflammatory bowel disease or other etiology.
C.Difficile-Associated Diarrhea (CDAD) is a severe diarrhea caused by Clostridium difficile a species of Gram-positive bacteria of the genus Clostridium.
All diarrheas are suspect for C.difficile. Any patient with diarrhea of an unknown etiology will be placed in Contact Enteric Precautions per the CDC Guidelines until the etiology of the diarrhea has been determined and C.difficile has been ruled out. Nursing Staff will direct the MD to the CLOSTRIDIUM DIFFICILE, SUSPECTED OR CONFIRMED order set for recommended evidence based care.
1) Antibiotic Stewardship - goal is to optimize clinical outcomes while minimizing unintended consequences of antimicrobial use. Unintended consequences including toxicity, the emergence of resistant and pathogenic organisms (i.e., MRSA, Clostridium difficile). Pharmacy leads the antibiotic stewardship efforts.
1) Clinical Laboratory uses the PCR method of testing to identify C.difficile.
2) Infection Prevention and Control conducts inpatient surveillance in any inpatient location where denominator data can be collected with the exception of the NICU and newborn nursery. Infection Prevention and Control maintains a line listing of hospital acquired cases. Hospital acquired infections are reported at the Infection Prevention and Control/Employee Health Leadership Team on a regular basis and an IRIS is completed for all HAI/CDIF infections. Clusters of cases in one unit or area will be investigated and appropriate action taken.
Infection Control Precautions for C.Difficile-Associated Diarrhea
1) Contact Enteric Precautions are to be initiated by the healthcare provider (e.g. physician, nurse) as soon as CDAD is suspected.
2) In addition to standard precautions, contact enteric precautions should be initiated for any patient who is suspected to have or considered to be at risk for CDAD at the onset of symptoms and prior to receipt of C.difficile toxin testing results.
Contact Enteric Precautions
1.) Room Placement - All patients suspected of having CDAD should be placed in a private...