Transcript Clostridium Difficile

Clostridium difficile
Community Infection Control Nurses
Leicestershire, Northamptonshire & Rutland
PCT’s
Health Protection Agency Nurses
Leicestershire, Northamptonshire & Rutland
Social Care Providers
Leicestershire, Northamptonshire & Rutland
2006
What is Clostridium difficile?
 A bacterium that usually lives in the bowel
 First described in the 1930’s
 Not 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 pain
 Complications can include dehydration,
malnourishment and in extreme
circumstances blood poisoning and/or death
How is it spread ?
 Via the faecal/oral route
 Direct contact with contaminated equipment,
clients or the environment
 On 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.
Infectious Agent
C.difficile
Reservoir
Susceptible Host
C. difficile
Bowel
Environment
Portal of entry
Means of Transmission
Faecal/oral
Spores left on
contaminated hands,
equipment or in the
environment
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 disease
 People who have been exposed to the
bacteria
 People with a poor immune system
 People who have had abdominal surgery
How is it diagnosed ?
By sending a specimen of diarrhoea to the
laboratory
A sample should be taken as soon as
possible
Obtain a specimen pot and form from the GP
Using 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 laxatives
 Consideration of underlying diseases
 Appropriate 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 room
 Own toilet/commode
 Designated equipment (e.g. hoists, slings.)
 Daily clean of room paying particular attention
to horizontal surfaces
 Hand washing before entering the room and
after removing protective clothing
 Final 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 Washing
Six-Step Technique
Hand Washing
 Drying is essential
 Hand 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
environment
 When assisting a client to use the toilet
 When undertaking cleaning activities
 Must be disposed of immediately after use
and before caring for another client
Cleaning and Decontamination
It 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 handles
Bedpans, commode pans and urinals should be
washed with hot water and detergent, rinsed
and allowed to dry
Chlorine-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)
Laundry
 At home soiled items should go directly into
the washing machine
 Soiled 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 loaded
Hands should be washed after handling soiled linen
Spillages
 Spillages should be dealt with immediately
 Protective clothing should be worn
 Clean up using a disposable cloth/paper
towel
 Area 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