clostridium difficile - a community perspective
DESCRIPTION
A presentation about clostridium difficile in the community given at the Wirral Community NHS Trust Infection Prevention & Control study day 2014TRANSCRIPT
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Clostridium difficile A Community Perspective
Helen Oulton
Head of Infection Preventionand Control
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Clostridium difficile
• Gram+ spore forming anaerobic bacterium
• Faecal - oral route• Survive in environment
for extended periods• Hands, hands, hands!• Resistant to alcohol
gel• Resistant to some
disinfectants
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Symptoms?
•Diarrhoea•Abdominal pain•Blood or mucus in faeces•High temperature•Loss of appetite•Nausea
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Risk Factors
• Age • Severe underlying disease• Immunosuppression• Environment with close contact of others e.g. care home• Antibiotic use (previous and current therapy)• Hospitalisation• Chemotherapy• Recent gastrointestinal procedures• Presence of a nasogastric tube• Use of Proton Pump Inhibitors (PPIs)
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Clostridium difficile
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Patient A
• Day 1. Patient A, a 77 year old male admitted to secondary care ? Urinary sepsis
• Day 2. CT - Pseudomembranous colitis
• Day 3. Patient died. Pseudomembranous colitis recorded on Part 1 of death certificate
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Pseudomembranous Colitis
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Post Infection Review
• Serious untoward incident – STEIS
• No known Clostridium difficile positive result
• Multiple care services
• Timeline
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Loperamide
• Anti motility agent thought to slow down the rate at which the toxins produced by Clostridium difficile are cleared from the gut
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Post Infection Review
• No single electronic access to patient records
• Patient at increased risk of Clostridium difficile infection (CDI) but CDI as cause of diarrhoea not considered
• Use of Loperamide
• Faecal sample not obtained in line with PHE guidance
• Communication between agencies
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Contributory Factors
• Multiple courses of antibiotic therapy
• Previous episodes diarrhoea related to antibiotic therapy treated with Loperamide (self-administered)
• Long term Proton Pump Inhibitors (PPI’s)
• Delay in diagnosis/treatment as patient declined admission to hospital
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Remember!
• Diarrhoeal illness is a common cause of consultation within primary care with the majority of cases responding to simple interventions e.g. oral rehydration, withdrawal of medication
HOWEVER………………………
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Be Clostridium difficile Aware
• Know the risk factors
• Confirm antibiotic history before prescribing
• Avoid anti motility drugs
• Prompt faecal sampling
• Rigorous infection prevention and control standards
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The Future?
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Any questions?