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C. diff infections rise: Use these practices
Clostridium difficile (C. difficile) infections are on the rise, with an estimated 500,000 cases in hospitals and nursing homes each year and increased mortality rates, according to the Centers for Disease Control and Prevention (CDC).1
"Half of all C. difficile cases present from the community," says L. Clifford McDonald, MD, FACP, FSHEA, chief of the Prevention and Response Branch in the CDC's Division of Healthcare Quality Promotion. "This includes patients transferred from nursing homes and persons recently discharged from acute care hospitals."
McDonald gives these recommendations for ED nurses:
Consider C. difficile in any patient presenting with new onset diarrhea, especially if there is a history of antibiotic and/or inpatient healthcare exposure in the previous three months.
"ED staff should be in the habit of inquiring about these exposures and obtaining a history of diarrhea, including stool frequency and consistency," says McDonald.
If the history and symptoms are consistent with C. difficile, such as more than three unformed stools in a 24-hour period, order a diagnostic assay.
Use contact precautions including gown and gloves, to prevent cross transmission, and clean all reusable patient care equipment before use with another patient.
Ben Brooks, RN, BSN, an ED nurse at St. Elizabeth Healthcare Florence (KY), says that it is important to use precautions even when caring for a potential C. difficile patient. "Even during brief patient encounters, it is very important to wash your hands to prevent the transmission of C. difficile," says Brooks. "Offer to help the patient clean or sanitize their hands often."
Brooks says to wear gloves to enter the room. "Wear a gown for direct patient care touching or cleaning up the patient," he says. "Remove the gown before leaving the room."
Wearing gloves can significantly reduce the spread of C. difficile, says Brooks. "After gloves are removed, wash hands with soap and water or an alcohol hand sanitizer before and after patient contact, or after contact with room surfaces," he adds.
C. difficile contaminates patient care equipment and devices through fecal shedding and the soiled hands of the patient or the healthcare worker, notes Brooks. "A plan should be in place to clean and disinfect surfaces when fecal contamination has occurred," he says. (See tip on preventing cross-contamination, below.)
For more information on ED patients with Clostridium difficile infections, contact:
Reduce risks: Give patient own supplies
If you are caring for a patient with Clostridium difficile infection, assign him or her disposable supplies or equipment whenever possible, says Ben Brooks, RN, BSN, an ED nurse at St. Elizabeth Healthcare Florence (KY).
"This can minimize cross-contamination," Brooks explains.