Clostridium difficileCommunity Infection Control Nurses

Leicestershire, Northamptonshire & Rutland PCT’s

Health Protection Agency NursesLeicestershire, Northamptonshire & Rutland

Social Care Providers Leicestershire, Northamptonshire & Rutland

2006

What is Clostridium difficile?

A bacterium that usually lives in the bowelFirst described in the 1930’sNot identified as a cause of diarrhoea and

colitis following antibiotic treatment until the late 1970’s

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

What does it cause ?

Explosive/offensive diarrhoea and occasionally vomiting

Abdominal painComplications can include dehydration,

malnourishment and in extreme circumstances blood poisoning and/or death

How is it spread ?

Via the faecal/oral routeDirect contact with contaminated equipment,

clients or the environmentOn 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.

C. difficile

ReservoirBowel

Environment

Infectious AgentC.difficile

Means of TransmissionSpores left on

contaminated hands,equipment or in the

environment

Portal of entryFaecal/oral

Susceptible Host

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 diseasePeople who have been exposed to the

bacteriaPeople with a poor immune systemPeople who have had abdominal surgery

How is it diagnosed ?By sending a specimen of diarrhoea to the

laboratoryA sample should be taken as soon as

possibleObtain a specimen pot and form from the GPUsing 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

How is it treated ?

Review of current/previous antibiotic treatment

Review of current laxativesConsideration of underlying diseasesAppropriate antibiotic drug treatment

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).

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

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

Isolation Precautions

Single roomOwn toilet/commodeDesignated equipment (e.g. hoists, slings.)Daily clean of room paying particular attention

to horizontal surfacesHand washing before entering the room and

after removing protective clothingFinal clean of room

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.

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

Hand WashingSix-Step Technique

Hand Washing

Drying is essentialHand 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

Personal Protective Equipment (PPE)

Gloves and aprons must be worn when: In contact with the client or their immediate

environmentWhen assisting a client to use the toiletWhen undertaking cleaning activitiesMust be disposed of immediately after use

and before caring for another client

Cleaning and DecontaminationIt 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 handlesBedpans, commode pans and urinals should be washed with hot water and detergent, rinsed and allowed to dryChlorine-based solutions (i.e. Milton) may be used on toilet seats and other surfaces after visible soiling has been removed

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)

LaundryAt home soiled items should go directly into

the washing machineSoiled 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 loadedHands should be washed after handling soiled linen

Spillages

Spillages should be dealt with immediatelyProtective clothing should be wornClean up using a disposable cloth/paper

towelArea should be cleaned using warm water

and detergent, rinsed and dried. Disinfect with a chlorine-based solution (i.e.

Milton), rinse and dry.

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

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

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

Any Questions