They say that there is more than one way to skin a cat, and controlling C-diff in a healthcare setting also requires a multi-faceted game plan. Parts of the plan should include antibiotic protocols, standard precautions, contact precautions and care of the environment.

Every facility should develop programs that encourage the proper use of antibiotics. As we have discussed previously, residents in healthcare facilities, especially those with prolonged stays, often go through a series of antibiotic treatments. And ironically, it is those regimens that often lead to the acquisition of viruses like C.diff as the body loses its natural ability to fight off infection and the virus builds immunity to the antibiotic. Thus, careful scrutiny and monitoring of antibiotic treatments is essential.

The best way to begin the fight against C.diff is the use of what are known as standard precautions for all residents, including those who have diarrhea with known or unknown etiology. Among these precautions are good hand hygiene using soap and water to wash hands, wearing gloves whenever delivering direct care, wearing gowns when dealing directly with a patient in the patient’s environment, using other PPE such as masks and face shields as deemed necessary and prudent and thoroughly cleaning all equipment and medical instruments after use.
More stringent contact precautions should be used for patients with uncontrollable diarrhea. In some facilities patients share rooms, but those known to be infected should be placed in a private room with a bathroom that is used solely for that resident.

As with standard precautions, good hand hygiene should always be practiced with regular soap or antimicrobial soap and water. Alcohol hand rubs are not sporicidal and therefore may be suboptimal for use when handling residents with CDI. Gloves should be put on before entering the room and worn at all times when in contact with the resident and the resident’s environment. The same applies to gowns. Resident care equipment and supplies should be dedicated to single patient use. If this is not possible, clean and disinfect equipment and items between residents.

C. difficile is found in feces and in the case of a patient with diarrhea, the virus can really be spread around the environment of a patient room. This makes it difficult to maintain a truly clean and disinfected environment.
The most effective disinfection procedures include the following. Rooms should be cleaned and disinfected daily using a 5.25% sodium hypochlorite (household bleach product) and water in a 1:10 dilution. The procedure should be repeated upon discharge of the resident or termination of contact precautions.

To gain the maximum benefit from these procedures, personnel using the cleaning products must adhere to the special precautions for their use, and management personnel must ensure that the proper procedures are being used consistently. With the use of this multi level procedure for fighting C.diff, healthcare facilities can mitigate the dangers of this virus. That yields healthier patients, and that, after all, is what healthcare is all about.
Information in this story is derived from an article appearing in the Pa Patient Saf Advis 2010 Mar 18;7(Suppl 1):10-5. titled Clostridium Difficile Infections in Nursing Homes.

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