Clostridium%20difficile

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Clostridium difficile

• Community Infection Control Nurses
• Leicestershire, Northamptonshire Rutland PCTs
• Health Protection Agency Nurses
• Leicestershire, Northamptonshire Rutland
• Social Care Providers
• Leicestershire, Northamptonshire Rutland
• 2006

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What is Clostridium difficile?

• A bacterium that usually lives in the bowel
• First described in the 1930s
• Not identified as a cause of diarrhoea and
  colitis following antibiotic treatment until the
  late 1970s

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Where is Clostridium difficile found ?

• Can normally be found in the bowel in a small
  proportion of the healthy adult population
• Is common in the bowel of babies and infants but
  rarely causes problems

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What does it cause ?

• Explosive/offensive diarrhoea and occasionally
  vomiting
• Abdominal pain
• Complications can include dehydration,
  malnourishment and in extreme circumstances blood
  poisoning and/or death

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How is it spread ?

• Via the faecal/oral route
• Direct contact with contaminated equipment,
  clients or the environment
• On the hands of carers/healthcare workers
• People having a normal bowel action are not
  thought to be an infection risk to others risk or
  need treatment.

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Infectious Agent C.difficile
Reservoir Bowel Environment
Susceptible Host
C. difficile
Portal of entry Faecal/oral
Means of Transmission Spores left on contaminated
hands, equipment or in the environment
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Who may be at risk ?

• Clients who have received certain antibiotics
• Those beyond the age of 65yrs
• Patients with underlying disease/illness
  cancer, chronic renal disease
• People who have been exposed to the bacteria
• People with a poor immune system
• People who have had abdominal surgery

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How is it diagnosed ?

• By sending a specimen of diarrhoea to the
  laboratory
• A sample should be taken as soon as possible
• Obtain a specimen pot and form from the GP
• Using the appropriate Personal Protective
  Equipment (PPE), take a specimen of diarrhoea
• Ensure pots and forms are labelled with the
  correct name and date of birth
• Ensure specimen reaches the GP surgery

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How is it treated ?

• Review of current/previous antibiotic treatment
• Review of current laxatives
• Consideration of underlying diseases
• Appropriate antibiotic drug treatment

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Guidance on Drug Treatment for Adults

•  1ST LINE TREATMENT
• Metronidazole 400mg x 3 daily for 14 days
•  
• If after 12 days, the patient is symptomatic,
  please contact either the Health Protection
  Agency (0116 263 1400) or Consultant
  Microbiologist via the Leicester Royal Infirmary
  (insert own contact numbers).
•   
• If in doubt contact your Infection Control
  Team/Nurse or the lead of your Infection Control
  Group (inset own contact numbers).

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Infection Control Precautions

• Infection Control action to prevent the spread
  of infection and therefore to prevent further
  cases is important. Make sure that you have
  implemented appropriate infection control
  procedures which include
• Isolation of clients whilst they have diarrhoea
• Effective thorough hand washing practices
• Use of protective clothing

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Infection Control Precautions

• Cleaning and decontamination of the environment
  and equipment (e.g. hoists, rooms etc)
• Safe management of soiled laundry and waste
• Management of body fluid spillages

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Isolation Precautions

• Single room
• Own toilet/commode
• Designated equipment (e.g. hoists, slings.)
• Daily clean of room paying particular attention
  to horizontal surfaces
• Hand washing before entering the room and after
  removing protective clothing
• Final clean of room

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All Clear

• When the client has had no diarrhoea for 48 hours
  and has normal bowel action, they are no longer
  considered an infection risk to others.
• No further specimens are required to confirm the
  client is C. difficile negative.

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Hand Washing

• Hand hygiene is one of the key interventions in
  reducing the spread of all infections especially
  C. difficile associated diarrhoea
• Must be done by all Healthcare Workers, relatives
  and other carers before caring for a symptomatic
  person and after removal of protective clothing
• Liquid soap and warm running water should be used
  to wash hands

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Hand WashingSix-Step Technique
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Hand Washing

• Drying is essential
• Hand washing must be done
• - After handling clothing, bedding, contact
  equipment
• - After visiting toilet/using commode
• Towels should not be shared (staff in
  Residential/Nursing homes should not use
  residents towels)
• Alcohol hand rubs are not effective against
  Clostridium difficile

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Personal Protective Equipment (PPE)

• Gloves and aprons must be worn when
• In contact with the client or their immediate
  environment
• When assisting a client to use the toilet
• When undertaking cleaning activities
• Must be disposed of immediately after use and
  before caring for another client

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Cleaning and Decontamination

• It is essential that the following surfaces are
  washed with hot, soapy, water, rinsed and dried
  at least daily or more frequently if possible
• Toilet seats, flush handles, hand wash basin
  taps, horizontal surfaces and toilet door
  handles
• Bedpans, commode pans and urinals should be
  washed with hot water and detergent, rinsed and
  allowed to dry
• Chlorine-based solutions (i.e. Milton) may be
  used on toilet seats and other surfaces after
  visible soiling has been removed

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Cleaning and Decontamination

• An allocated mop, bucket and disposable cloth
  should be kept in the room of the affected
  patient
• Ideally mops with disposable heads should be used
  and the mop heads disposed of at the end of the
  episode of illness
• No cleaning of soiled items should take place in
  food preparation areas (e.g. sinks in kitchens)

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Laundry

• At home soiled items should go directly into the
  washing machine
• Soiled laundry should be put into a plastic bag
  if staff are not able to put linen directly into
  a washing machine
• Clothing should be washed separately from other
  clothing on the hottest temperature the fabric
  will allow
• The outside of the washing machine should be
  wiped down with hot water and detergent after
  soiled laundry is loaded
• Hands should be washed after handling soiled
  linen

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Spillages

• Spillages should be dealt with immediately
• Protective clothing should be worn
• Clean up using a disposable cloth/paper towel
• Area should be cleaned using warm water and
  detergent, rinsed and dried.
• Disinfect with a chlorine-based solution (i.e.
  Milton), rinse and dry.

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Spillages

• If spillage occurs on carpeted area, ideally a
  carpet shampoo or steam clean should be
  undertaken.
• All accessible parts of the cleaner should also
  be cleaned following use

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Exclusion from Outside Activities

• All cases of diarrhoea should be regarded as
  potentially infectious and should normally be
  excluded from outside activities for at least 48
  hours after the person is free from diarrhoea
  and/or vomiting and has had a normal bowel action

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Can it come back ?

• Staff should be aware of the possibility of the
  re-occurrence of diarrhoea
• A significant proportion of clients may relapse
  following further antibiotic treatment
• If re-occurrence of diarrhoea develops then
  infection control precautions must be implemented
  until the client has had no diarrhoea for 48
  hours and is having a normal bowel action

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Any Questions