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Volume 102, January 2021, Pages 188-195
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Healthcare associated infection
Clostridioides difficile (also known as C. difficile or C. diff.) is a bacterium that causes colitis, or inflammation (swelling) of the colon. The infection usually occurs when people, particularly the elderly who are also receiving medical care, take antibiotics over a long period of time.
Clostridioides difficile (pronounced klos-TRID-e-OY-dees dif-uh-SEEL), also known as C. diff. or C. difficile), is a germ that can cause diarrhea or a more serious intestinal condition such as colitis.
When a person takes antibiotics, the “good germs” in the intestines are killed off making it easier to become infected by the Clostridioides difficile germ. The germ is found in stool (bowel movement), and is spread to other people by unwashed hands, contaminated surfaces, or objects.
In a healthcare setting, the germs have been found on objects such as toilets, bathroom fixtures, bed rails, and rectal thermometers. The germ is able to survive for a very long time on a variety of surfaces.
What are the symptoms of Clostridioides difficile?
Symptoms may include:
- Watery diarrhea
- Fever
- Loss of appetite
- Nausea or vomiting
- Stomach (belly) pain or tenderness
Clostridioides difficile is diagnosed by testing the stool of patients who are having frequent liquid diarrhea such as 3 or more stools in a 24 hour period. In a severe case, a procedure called flexible sigmoidoscopy may be performed to confirm that the lower part of the intestine (colon) is inflamed. In this procedure a long, thin tube called a sigmoidoscope is placed inside the intestine to allow a doctor to visually examine the colon.
Clostridioides difficile is usually treated with antibiotics prescribed by your healthcare provider. In rare severe cases, a person might need to have surgery to remove the infected part of the intestine. Patients who have Clostridioides difficile infection should not use drugs to control diarrhea unless prescribed by their healthcare provider as this could make the infection worse.
Clostridium difficile: Infection Prevention and Contact Precautions
To prevent Clostridioides difficile infection, hospitals and nursing homes take the following precautions:
- Ask the patient to clean their hands after using the bathroom.
- Make sure all healthcare providers clean their hands before and after caring for every patient.
- Use a disinfectant to clean rooms and equipment.
- Give patients antibiotics only when necessary.
- Alert any facility to which a Clostridioides difficile patient may be transferred.
When caring for patients with Clostridioides difficile hospitals and nursing homes will:
- Place patients with Clostridioides difficile infection in a private room whenever possible.
- Place the patient in Contact Precautions, also known as isolation. Healthcare providers wear gloves and a gown over their clothing when entering the room and wash their hands with soap and water when leaving the room.
- Have patients with Clostridioides difficile infection remain in their room unless they need to leave for medically necessary treatments or therapies.
- Ask visitors, or anyone entering the room, to clean their hands when they come in and before they leave the room.
Hospitals and nursing homes may also ask the patient’s visitors to:
- Wear gloves and a gown especially if they are helping to provide care.
- Not eat or drink in the patient’s room.
- Not use the patient’s bathroom.
What do I do after returning home from the hospital?
You can return to your normal routine once you are back at home. The diarrhea is often better or gone before you go home, which makes the spread of Clostridioides difficile to others much less likely.
You can lower the chances of developing Clostridioides difficile infection again or spreading it to others. For example:
- Take your medication to treat Clostridioides difficile exactly as instructed by your healthcare provider and pharmacist. Take all the medication as directed. Do not take half-doses or stop before you have taken all the medicine.
- You and your family members should wash their hands after going to the bathroom, before preparing or eating food, and when hands are dirty.
- Clean surfaces in bathrooms and kitchens regularly with household detergents/disinfectants.
- Tell your healthcare provider if your diarrhea returns.
Antibiotics for Clostridioides difficile are usually an effective treatment. Fever usually goes away within 2 days, and diarrhea ends in 2 to 4 days.
In about 10-20% of patients, symptoms may recur (return) within 1 to 2 weeks of ending treatment. Tell your healthcare provider if your diarrhea returns.
Last reviewed by a Cleveland Clinic medical professional on 04/24/2019.
References
- Centers for Disease Control and Prevention. Clostriodes difficile infection. (//www.cdc.gov/hai/organisms/cdiff/Cdiff-patient.html) Accessed 4/24/2019.
- American College of Gastroenterology. Guidelines for Diagnosis, Treatment and Prevention of Clostridium difficile Infections. (//gi.org/guideline/diagnosis-and-management-of-c-difficile-associated-diarrhea-and-colitis/) Accessed 4/24/2019.
- The Merck Manual for Health Care Professionals. Clostridium difficile-Induced Diarrhea. (//www.merckmanuals.com/professional/infectious-diseases/anaerobic-bacteria/clostridioides-formerly-clostridium-difficile-induced-diarrhea?query=Clostridioides%20difficile) Accessed 4/24/2019.
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Professionals working in long term care facilities encounter a high percentage of people taking antibiotics. Healthcare workers often do not necessarily view elderly patients as a potential health risk simply because they take needed medications. But continued antibiotic usage can result in the presentation of Clostridium difficile (C diff), a health hazard that tends to be a byproduct of extended antibiotic cycles.
Healthcare professionals and those tasked with maintaining cleanliness in senior facilities do not need to have direct contact with patients to contract C diff. That’s why department of health standards require staff members to wear disposable personal protective clothing such as lab coat. If you work in an environment where our valued elders are prescribed long-term antibiotics, the following information covers contact precautions for C diff and general C diff precautions for healthcare workers.
What Elder Care Professionals Need to Know About Clostridium difficile
Clostridioides difficile is a bacterium that can cause serious inflammation of the intestines (colon). Commonly called “C diff,” seniors in assisted living facilities are prone to contracting this ailment during prolonged antibiotic use. It can be a byproduct of medications designed to target specific conditions that an elderly patient is struggling to ward off. Although C diff is usually not life-threatening when detected early in relatively healthy people, the symptoms can create tremendous discomfort. These include the following.
- Intense Diarrhea
- High Fever
- Appetite Loss
- Nausea
- Stomach and Intestinal Discomfort
It may seem almost counterintuitive, but C diff is treatable through antibiotics. In severe cases, 1- to 2-percent of C diff patients require surgery, and portions of infected intestines are removed. C diff presents a heightened health risk, and many caregivers are unaware that it even exists. It’s imperative that healthcare professionals and those tasked with senior living facility cleanup understand the dangers of C diff, how it is transmitted, and that they wear disposable protective clothing to minimize contracting or spreading it.
How C diff Spreads in Senior Living Facilities
The infection has a high rate of transmission from person-to-person contact. Caregivers administering medication, conducting sponge bathing, or simply offering the comfort of holding a patient's hand can result in a C diff infection unless certified disposable protecting clothing is worn.
But perhaps the single most challenging aspect of working in an environment prone to C diff is that the spores can live outside the body. Drifting spores can attach themselves to items that caregivers and cleaning crews routinely encounter, including the following.
- Bed Sheets
- Pillowcases
- Rails
- Countertops
- Bathroom Fixtures
- Medical Equipment
- Wheelchairs
C diff spores also have significant longevity away from a human host. Inadvertently picking up a C diff spore can cause direct illness. They can also be passed along to coworkers through direct or indirect contact.
Spores may even find their way to a caregiver’s family if protective clothing is worn home after a shift. According to the Mayo Clinic, about 170,000 infections occur each year outside of health care settings, and this figure is rising. What’s crucial for senior caregivers and cleanliness workers to keep in mind is that Clostridium difficile infections have the potential to spread quickly.
How To Stop C diff From Spreading
Hospitals and elder patient care facilities must adhere to the strictest protocols to minimize the risk that infections such as C diff spread from patient-to-patient or cause an outbreak among staff members. The Center for Disease Control and Prevention (CDC), advocates that people working in healthcare facilities adhere to the following guidelines to prevent the spread of C diff.
- Thorough hand hygiene: Clean hands with soap and water or an alcohol-based hand rub before and after caring for every patient.
- Cleaning and disinfection: Thoroughly clean hospital rooms and the medical equipment of patients diagnosed with C diff.
- Private rooms: Implement precautions such as assigning C diff patients to a single or private room.
- Healthcare PPE for C diff: Caregivers must wear disposable protective gloves and a disposable protective gown over clothing
- C diff PPE for visitations: Visitors should be asked to also adorn personal protective gowns and gloves when visiting patients with C diff.
The CDC also strongly advocates that people who enter C diff patient rooms promptly and safely dispose of the personal protective clothing to prevent spores from spreading. The health agency also calls for people to sanitize and clean their hands and any exposed skin immediately.
What is the proper PPE for C diff?
Although physicians do their best to minimize the use of long-term antibiotic treatments, our valued elders often face significant health challenges. It’s up to caregivers to have high-level knowledge about associated risks and maintain the most sanitary environment possible.
Disposable protective clothing remains a front line of defense against C diff spreads. These are things you should know about maximizing the use of disposable protective clothing.
- Disposable protecting clothing reduces the risk of C diff spread between providers, residents, staff members, and can eliminate the risk of facility-wide colonization. Disposable PPE prevents the spread of the spores to laundering personnel, laundering equipment, or others if the clothing is worn outside of the workplace.
- Elderly residents are considered most contagious when C diff symptoms such as diarrhea are present before treatment as begun. Skin-to-skin and skin-to-clothing contact is likely to spread C diff infections at this stage.
All team members working in an elder living facility are advised to wear disposable personal protective clothing when providing caregiver or cleaning services. It’s essential these clothing options deliver high-level protection and are properly discarded following a visit to a C diff patient. International Enviroguard's protective clothing is a leading defense in eldercare health and safety.
These are necessary procedures that staff members follow to reduce the risk of infection:
- Wash hands with antibacterial soap or gel sanitize
- Put on disposable clothing including a lab coat or gown, eye covers, and mask
- Wear disposable protective gloves
When exiting the room of a C diff patient, remove and dispose of the protective equipment in this order.
- Gloves
- Eye coverings
- Lab coat or Gown
- Mask
Complete your exit strategy by thoroughly washing and sanitizing hands before coming into contact with other patients, loved ones, or team members.
The best way to avoid contracting an infectious disease is to consistently utilize protective clothing, effectively dispose of it, and practice thorough sanitization procedures. It’s imperative that eldercare facilities and hospital settings provide staff members at every level with the necessary personal protective equipment to maintain the highest health and safety standards. While C diff ranks among the more common health risks in senior care facilities, providers and cleanup staff members must remain vigilant about unknown dangers as well.