Presentation on theme: "Clostridium Difficile Infectious Diarrhea"— Presentation transcript:
1 Clostridium Difficile Infectious Diarrhea (CDI)Infection Prevention Learning ModulePrepared by Infection Prevention and Control ServicesVancouver Island Health Authority
2 Infectious DiarrheaThere are many pathogens responsible for causing diarrhea illness in humans. Of concern to health care facilities are:NorovirusE coli 0157:H7RotavirusClostridium difficileThe most contagious of these is Norovirus but the one most likely to cause serious and long lasting disease in hospitalized patients is C. difficile !
3 Clostridium Difficile Clostridium difficile is a gram positive spore forming bacillus that lives in the intestinal tract of healthy peopleC. Difficile is also found in soil, water and animal feces
4 Clostridium Difficile People can become colonized with C. difficile and have no symptomsAntibiotics given for other infection destroy normal flora of the gut and allow over growth of this bacteriaC. difficile produces toxin which attacks the lining of the intestinal tract leading to malabsorption of fluids and nutrients
5 Clostridium Difficile Symptoms of CDAD can include:watery diarrhea (more than 3 loose stools within a 24hr period)feverloss of appetitenauseaabdominal pain/tendernessDiarrhea can lead to serious complications, including dehydration, loss of bowel tissue function, toxic megacolon and death.
6 Clostridium Difficile Associated Diarrhea (CDAD) People at greatest risk for infection have:other illnesses and/or are elderly (eg. immunocompromised), orconditions requiring use of broad spectrum antibiotics (eg. Clindamycin, Cephalosporins, Fluoroquinolones (Gatifloxacin))
7 The risk of becoming colonized when in hospital is higher than 25% - WHY? People are exposed to C. difficile Contaminated Environmental Surfaces/fomites
8 People are exposed When: Patients not recognized as having CDI contaminate the environmental surfaces andThese surfaces are inadequately cleaned and disinfection with a chemical capable of killing the sporesContaminated hands or clothing transfer the bacteria from ill patients to others within their care
9 SurveillanceIncidence of CDAD infections has been on the rise in Canadian Acute Care facilities
10 SurveillanceThe average determined in the 1997 national surveillance was 5.9 cases per 1000 admissionsDisease tracking across the country suggests that infections are on the rise. Outbreaks have occurred throughout VIHA in recent yearsEach case of CDAD represents 7 to 15 additional days of hospital stay
11 Infection Reduction Strategies The following strategies have been shown to reduce the incidence of healthcare associated C. difficile colitis infections (CDI)
12 Reduction Strategies Early Recognition Suspect CDI in anyone who is admitted with or develops diarrhea of undetermined causePeople can develop symptoms from 2 or 3 days to 1 month after exposure to the bacteria
13 Reduction Strategies 2. Patient Placement Manage in a private room If no private room available, admit to semi-private andPatient/resident to use dedicated commode or toilet
14 Reduction Strategies 3. Laboratory Confirmation Send first available stool for C. difficile toxin studies using regular dry C & S containerInformation on requisition – note any recent antibiotic administeredResults:Toxin Positive = infectionToxin Negative with diarrhea + lab comment referred for Cytotoxin studies = probable InfectionCytotoxin positive = InfectionToxin Negative & Cytotoxin negative = diarrhea NYD (continue precautions until Diagnosis made or diarrhea resolved x 3 days)
16 Reduction Strategies 4. Infection Control Interventions Contact precautions signage on curtain OR at foot of bed if in the semiprivate roomPlace patient name on dedicated commode/ wheelchairWear gown and gloves for personal careWash hands with soap & water as alcohol hand sanitizers do not penetrate the spore shell.
17 Reduction Strategies Environmental Management 2 STEP cleaning and disinfectionHousekeeping to use Accelerated Hydrogen Peroxide (AHP-Virox) to disinfect bed space contact surfaces twice dailyTerminal disinfection with AHP twice upon dischargeMinimal supplies and equipment are taken into room and dedicate these to the room/patient whenever possibleAll care & assessment equipment to be cleaned & disinfected by nurses when removed from room using Accelerated Hydrogen Peroxide (Virox)
18 Reduction Strategies 6.Personal Care Bed pans/commode pots must be cleaned and disinfectedusing the mechanical washer disinfector orrinsed emptied toilet of private room or soiled utility hopper if patient in semiprivate and them cleaned with AHP before reuseChange the wash basin daily and following peri careHandle soiled linen with care & directly into the tote (Do not throw soiled linen on floor !)
19 Reduction Strategies Patient & Visitor education Visitors who will provide personal care are to wear gown and glovesInstruction on hand-washing with soap & waterAll patients confirmed to have CDI to receive a copy of the “Patient Information Pamphlet”Patients may be out of room for ambulation provided:They are not incontinent of stool presentlyThey wear a clean hospital issue robeThey wash their hands with soap and water prior to leaving the room
21 Notification & Records Notify person responsible for Infection ControlNote any recent past admission to hospital, reason for this admission and type of antibioticTranscribe relevant information and Infection Control precautions in KardexNotify Most Responsible Physician (MRP) of clinical signs & suspicionsNotify any receiving or diagnostic department & porters while diarrhea is present
22 Treatment & Patient Disposition Toxin +Will require either Metronidazole or Vancomycin oral therapyToxin –If diarrhea persists, on the third day resend specimen for C. diff Toxin and contact the physician. The physician may treat.If diarrhea resolves while you wait the three days then the patient may be colonized or has diarrhea provoked by another pathogen or physiological cause
23 Treatment & Patient Disposition Once appropriate treatment is started, patient can be cohorted with another CDAD patient also receiving treatmentInfection Control measures can be discontinued once patient has no diarrhea for 3 days and stools are documented as being formed2 STEP Terminal cleaning and disinfection of bed and room must be done before the precautions are discontinuedThis is accomplished by placing the patient on a clean stretcher or in a clean Broda Chair while the room is being cleanedOnce this is done and all dedicated equipment is disinfected, then the precautions are discontinued… alert Infection Control that this has occurred
24 FeedbackRates of CDI for your facility and ward will be published and circulated quarterly or at defined intervals by Infection Prevention & ControlWe invite yourfeedback
25 New references needed! - dc VIHA Infection Control Manual, pp. 2 – 14, 2 – 21 and 2 – 28Shea Position Paper, Clostridium Difficile-Associated Diarrhea & Colitis, Infection Control & Hospital Epidemiology, Vol 16, No. 8, pp. 459 – 477Infectious Diseases & Microbiology, December 2004, Vol 3, Issue 10New references needed! - dc