Clostridium difficile lesson #2
What are the main clinical symptoms of Clostridium difficile infection?
Clinical symptoms include:
- watery diarrhea
- fever
- loss of appetite
- nausea
- abdominal pain/tenderness
Which patients are at increased risk for Clostridium difficile infection?
The risk for disease increases in patients with:
- antibiotic exposure
- proton pump inhibitors
- gastrointestinal surgery/manipulation
- long length of stay in healthcare settings
- a serious underlying illness
- immunocompromising conditions
- advanced age
What are the differences between Clostridium difficile colonization and Clostridium difficile infection?
Clostridium difficile colonization
- patient exhibits NO clinical symptoms
- patient tests positive for Clostridium difficile organism and/or its toxin
- more common than Clostridium difficile infection
Clostridium difficile infection
- patient exhibits clinical symptoms
- patient tests positive for the Clostridium difficile organism and/or its toxin
How is Clostridium difficile transmitted?
Clostridium difficile is shed in feces. Any surface, device, or material (e.g., commodes, bathing tubs, and electronic rectal thermometers) that becomes contaminated with feces may serve as a reservoir for the Clostridium difficile spores. Clostridium difficile spores are transferred to patients mainly via the hands of healthcare personnel who have touched a contaminated surface or item.
How can Clostridium difficile infection be prevented in hospitals and other healthcare settings?
Preventive measures include:
- Hand-washing. Health care workers should practice good hand hygiene before and after treating each person in their care. In the event of a C. difficile outbreak, using soap and warm water is a better choice for hand hygiene, because alcohol-based hand sanitizers do not effectively destroy C. difficile spores. Visitors also should wash their hands with soap and warm water before and after leaving the room or using the bathroom.
- Contact precautions. People who are hospitalized with C. difficile have a private room or share a room with someone who has the same illness. Hospital staff and visitors wear disposable gloves and gowns while in the room.
- Thorough cleaning. In any setting, all surfaces should be carefully disinfected with a product that contains chlorine bleach. C. difficile spores can survive routine cleaning products that don’t contain bleach.
- Avoid unnecessary use of antibiotics. Antibiotics are sometimes prescribed for viral illnesses that aren’t helped by these drugs. Take a wait-and-see attitude with simple ailments. If you do need an antibiotic, ask your doctor to prescribe one that has a narrow range and that you take for the shortest time possible.
- Use antibiotics judiciously
- Use Contact Precautions: for patients with known or suspected Clostridium difficile infection:
o Place infected patients in private rooms. If private rooms are not available, these patients can be placed in rooms (cohorted) with other patients with Clostridium difficile infection.
o Use gloves when entering patients’ rooms and during patient care.
o Perform Hand Hygiene after removing gloves.
Because alcohol does not kill Clostridium difficile spores, use of soap and water is more efficacious than alcohol-based hand rubs. However, early experimental data suggest that, even using soap and water, the removal of C. difficile spores is more challenging than the removal or inactivation of other common pathogens.
Preventing contamination of the hands via glove use remains the cornerstone for preventing Clostridium difficile transmission via the hands of healthcare workers; any theoretical benefit from instituting soap and water must be balanced against the potential for decreased compliance resulting from a more complex hand hygiene message.
If your institution experiences an outbreak, consider using only soap and water for hand hygiene when caring for patients with Clostridium difficile infection.
o Use gowns when entering patients’ rooms and during patient care.
o Dedicate or perform cleaning of any shared medical equipment.
o Continue these precautions until diarrhea ceases.
- Because Clostridium difficile-infected patients continue to shed organism for a number of days following cessation of diarrhea, some institutions routinely continue isolation for either several days beyond symptom resolution or until discharge, depending upon the type of setting and average length of stay.
- Implement an environmental cleaning and disinfection strategy:
o Ensure adequate cleaning and disinfection of environmental surfaces and reusable devices, especially items likely to be contaminated with feces and surfaces that are touched frequently.
o Consider using an Environmental Protection Agency (EPA)-registered disinfectant with a sporicidal claim for environmental surface disinfection after cleaning in accordance with label instructions; generic sources of hypochlorite (e.g., household chlorine bleach) also may be appropriately diluted and used. (Note: Standard EPA-registered hospital disinfectants are not effective against Clostridium difficile spores .) Hypochlorite-based disinfectants may be most effective in preventing Clostridium difficile transmission in units with high endemic rates of Clostridium difficile infection.
o Follow the manufacturer’s instructions for disinfection of endoscopes and other devices.
- Recommended infection control practices in long term care and home health settings are similar to those practices taken in traditional health-care settings.
References
http://www.cdc.gov/hai/organisms/cdiff/cdiff_faqs_hcp.html#a1