Guest Columns

Taking steps to prevent Clostridium difficile infections

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Irena Kenneley
Irena Kenneley

The numbers are in and they are grim. There are 165,000 cases, $1.3 billion in excess costs, and 9,000 deaths from Clostridium difficile infections that are healthcare-acquired in the United States annually.

Many of these infections affect residents of long-term care facilities. LTCF-onset infections caused by C. diff show that in this population there are 263,000 cases, $2.2 billion in excess costs, and 16,500 deaths annually.

Implications of C. diff. infections—Why is this Important?

  • Significantly higher death rate
  • Increased length of stay
  • Increased use of antibiotic therapy
  • Increased lab testing

The majority of C. difficile cases occur in healthcare settings, where organisms can spread easily, antibiotic use is common and people are especially vulnerable to infection. In long-term care facilities, C. difficile spreads mainly by the hands of healthcare workers and then person-to-person. The spread of C. difficile can also happen by touching contaminated cart handles, bedrails, bedside tables, toilets, sinks, stethoscopes, thermometers — even telephones and remote controls.

Risk Factors

Although people — including children — with no known risk factors have been infected by C. difficile, a resident's risk is greatest if they:
  • Are now taking or have recently taken antibiotics. The risk goes up if broad-spectrum antibiotics that target a wide range of bacteria are used, if multiple antibiotics or taking antibiotics for a prolonged period of time.
  • Are 65 years of age or older. The risk of becoming infected with C. difficile is 10 times greater for people age 65 and older compared with younger people.
  • Are now or have recently been hospitalized, especially for an extended period as in LTCFs.
  • Live in a nursing home or long-term care facility.
  • Have a serious underlying illness or a weakened immune system as a result of a medical condition or treatment (such as chemotherapy).
  • Have had abdominal surgery or a gastrointestinal procedure.
  • Have a colon disease such as inflammatory bowel disease or colorectal cancer.
  • Have had a previous C. difficile infection.

Infection Prevention and Control of C. difficile infection (CDI)

  1. Contact Precautions for duration of diarrhea
  2. Hand hygiene in compliance with CDC/WHO
  3. Cleaning and disinfection of equipment and environment
  4. Laboratory-based alert system for immediate notification of positive test results
  5. Educate about CDI: HCP, housekeeping, administration, patients, families
  6. Presumptive isolation for symptomatic patients pending confirmation of CDI
  7. Evaluate and optimize testing for CDI
  8. Implement soap and water for hand hygiene before exiting room of a patient with CDI
  9. Use sodium hypochlorite (bleach) – containing agents for environmental cleaning
  10. Implement an antimicrobial stewardship program
  11.  Extend use of Contact Precautions beyond duration of diarrhea (e.g., 48 hours)
  12.  Implement universal glove use on units with high CDI rates

Irena Kenneley, Ph.D., APRN-BC, CIC, is a member of the adjunct nursing faculty at American Sentinel University.



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Guest Columns

Guest columns are written by long-term care industry experts, ranging from academics and thought leaders to administrators and CEOs.


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