NARRATOR: In just the last few years, this bacterium has become a major threat to acute care as well as long term care facilities. Its name is Clostridium difficile or C. diff and it is the most common cause of infectious diarrhea in health care facilities. What troubles experts most is that C. difficile associated disease rates are rising quickly and it is becoming more severe.
If your facility has not yet seen C. diff. it probably will and you as a health care worker must be prepared. In this program, you will learn about the organism, understand how C. diff. is transmitted, learn how to quickly identify patients with C. difficile associated disease and understand what to do to prevent and control transmission of this new enemy.
Clostridium difficile is a gram positive and aerobic bacterium that lives in a human column. There are two forms: an active form or bacterial cell that can cause illness but does not survive well in the environment and the dormant form or spore that can live for a long period of time in the environment and is difficult to kill.
C. diff is found in feces and is very easy to spread to others. Any surface, object or material that becomes contaminated with feces can contain spores including floors, bedpans, toilets and diaper pearls; frequently touched surfaces in the patient’s environment such as linens, patient care equipment, furniture and telephones; and hands, fingernails and rings after touching contaminated surfaces.
The most common form of transmission is by the hands of health care workers. When a surface or item contaminated by spore is touched, the health care worker then carries the spores in their hands. These spores can then be transmitted to patients during mouth care, suctioning of respiratory secretions or other routine patient care activities. This is why good hand hygiene and wearing gloves at the appropriate times are so important.
The illness caused by C. diff. is called Clostridium difficile-associated disease or CDAD and they can range from a mild diarrhea to a life-threatening colitis. CDAD most often occurs during and after anti-biotic treatment in a health care facility but maybe delayed after six or more weeks after discharged. Other risk factors for CDAD include advanced age, immunocompromised state, prolonged, current or recent care in a healthcare facility, cancer therapy, abdominal conditions such as Crohn’s disease or surgery and previous infection with C. difficile, gastric acid suppressants such as proton-pump inhibitors might also increase the risk of C. diff.
Most patients will acquire C. diff as the result of recent hospitalization. However, there have been reports of community onset CDAD in previously healthy people with little or no exposure to a health care setting. That’s why CDAD should be suspected in anyone with severe diarrhea even if they don’t have traditional risk factors. Also it’s important to know that up to 30% of patients treated for C. diff. colitis may have a recurrence typically within two months.
What can be done to prevent and control C. diff. in a health care facility? Because C. diff. is easily transmitted and is difficult to remove from the environment, infection prevention and control measures are critical. Standard precaution should be practiced for all patient care and all health care settings. Not all patients who carry C. diff. show symptoms so hand hygiene must be practiced before and after all patient contact and patient roman counters.
Personal protective equipment should be used when there is a likelihood of contact with a potentially infectious material. This may include the use of gowns, masks and eye protection if there is the risk of splashing or spraying of any body substance. And there should be very careful attention given to the cleaning and disinfection of the patient care environment and patient care equipment. In addition to standard precautions, the CDC recommends placing all patients who have or are suspected of having CDAD under contact precautions. All contact precaution rooms have signs to warn health care workers that extra infection control measure