Q: When do we put a resident on isolation when we suspect a Clostridium difficile (C. diff) infection, and when can we remove the isolation?

A: Residents should be placed on contact precautions while they are experiencing diarrhea. Wait to discontinue precautions until the diarrhea resolves. Also, while the diarrhea is active, use bleach for daily cleaning of high-touch surfaces. We also require hand washing with soap and water instead of sanitizer, due to the potential for spores.

Of course, each case should be individually assessed. If a resident can’t seem to clear, or requires extended treatment for persistent diarrhea, allow him or her to leave the room as long as his or her hands are washed, clean clothes are worn and excretions are contained. It is suggested to make every effort to maintain a private room until the symptoms are resolved, but we know this can’t always happen. Keep the room and the resident as clean as possible, and if the active excretions cannot be contained, the resident should stay in the room, unfortunately.

Engaging with the family and providing the proper staff training will make things easier. Keep it simple. If the families are aware of what the isolation sign means and what to do, it will prevent them from being scared. It also will stop them from removing their loved one because they think the facility has some awful infection, and protect vulnerable visitors from C. diff.

If you go to the APIC website (www.apic.org), you can download a comprehensive sheet about C. diff  that explains what it is, the symptoms, about isolation, washing hands and how it is treated. It is a great one-page FAQ (Frequently Asked Questions). Enter “C. diff ” as the search term to find an entire library of great policies and in-service training material.