c. dif...clarifying differences

[jdruds]

Charge nurse had c. Dif a few years ago and ever since, when a patient is on r/o or confirmed everyone avoids having the assignment thinking they will get it. Don't get me wrong, going through 20 yellow gowns in a shift gives me no pleasure, but c. Dif changes nothing in my eyes. The misconception to staff came when he chose not to acknowledge the fact that he had been on three antibiotics fighting an infection he had been dealing with for weeks. Lately, we have been isolating everyone with one report of or observed diarrhea episode.

A clear diet and diarrhea? Must be c. dif...history of IBS with baseline loose stools? Must be c. dif...this mindset has been ridiculous and slowly has begun to change after bluntly explaining to him that it is not "contagious" and that he was at risk for acquisition based on his treatment regimen and predisposition. C. Dif is a spore and if the observed diarrhea has a shiny, mucousy look with a distinct pseudomonas smell THEN isolating to r/o makes sense. A patient on a general diet on antibiotic therapy who develops repeated episodes of diarrhea? Ah, now maybe c. dif makes sense.

Second misconception, we do not gown up to protect ourselves. We gown up to protect patient 1 on 6 weeks of antibiotic therapy from patient 2 with confirmed/suspected c. dif. Lack of immune defense is a risk factor. Because it is carried in spores, close the door when changing linen because studies have shown potential of air travel with air disturbances. Don't fear it: wash your hands, change out of your scrubs before hugging your family, and understand the facts. Knowledge is power. And hey, if you get it, the fecal transplant is pretty neat I've taken care of a few recipients!

[AZQuik]

C diff. Is not a spore. It is a type/species/common term for a certain bacteria, which is spore forming. Bleach will break down the spores. Soap and water (done correctly) will wash the spores down the drain. PPE usually keeps it off areas that aren't being washed. And it is an anaerobe which thrives in the human colon, particularly when colon flora is killed off due to antibiotic usage.

You can determine who gets ISO due to their loose stools, but know you risk spreading it. (I am not the poster child for who gets all the ISO work in my ER. Today a man pooring blood out of his rectum with formed.....blood clots! was put on contact precautions. Think I put up contact precautions? Nope! I transfused as rapid as I could. But they were ordered, for no reason other than he had liquid coming out of his orifice! It was clearly blood and I showed the doc the 900 mls from one session)

All that said, I have seen positive C diff. from completely formed stools with no puss. Be careful.