C-Diff & infection control

[CocoaGirl]

Are there any infection control recommendations for caring for a C-Diff positive patient in the chronic setting? Our unit has an alert & oriented nursing home resident who is obese & requires a hoyer lift to transfer into & out of the dialysis chair. Due to the hoyer lift size it will not fit into the patient bathroom. The resident is incontinent of foul, liquid stool that soils through their adult brief & clothing almost every treatment day. The patient is colonized with c-diff and has had treatment multiple times. We have been instructed by the area manager (non-medical) & the clinical manager that this patient will be changed in the chair by the staff when this occurs. There is no isolation room, this is an open unit with patients only a few feet away. (of course we put up privacy curtains during the changing process). Sometimes the stool ends up all over the hoyer sling & hemo chair. It is gross & smells up the whole unit, but what really concerns me is the risk to other patients. The alcohol based hand sanitizers are NOT effective against the clostridium spores. It takes a minimum of 3 staff members to do this changing process due to the size & immobility of the patient. (we only have 4 staff in the unit, period). We suggested that if the patient is incontinent to send them back to the nursing home and dialyze the next day at another unit since we are only a 3 day a week clinic. The patient would have an 45 minute drive back to the nursing home & have another 45 minute drive back to our unit. I feel like the clinical manager is not taking the risk to staff or the other patients seriously. Any suggestions??????

[traumaRUs, MSN, APRN]

I've never seen pts changed at HD that have c-dif. In the units where I work, if that situation occurs (with soiling) then the NH staff is called and they come and change the pt.

[anurseadvocate]

washing hands for 15 seconds with soap and water is the way to go. C-Diff is extremely contagious and runs rampant in nursing homes. If the patient is incontinent there is more chance of transfer of bacteria.

[Lacie, BSN, RN]

I've never seen pts changed at HD that have c-dif. In the units where I work, if that situation occurs (with soiling) then the NH staff is called and they come and change the pt.

Full agreement here, call the NH staff to come do it. Most dialysis units dont have the proper supplies to thoroughly change the pt particularly in adding privacy. We used to put curtains up but the pt in the next chair still had to deal with all the odor and it's almost impossible to give the privacy the pt deserves in an open bay area. Dialysis nurses have enough on thier plate to do tasks wise anyway without adding this addition.

[pielęgniarka, RN]

Maybe it's different with facilities that have HD on campus with LTC. I know the nursing home I work at we would never be able to spare nurses to leave & go to the dialysis center (which is off campus and in a different town) just to change a pt. It would be a huge liability too. I think dialysis should be called off with an accident like that and pt should be brought back to the nursing home. The primary MD should be notified that dialysis is not able to be completed due to the pts illness. Maybe this pt needs inpatient treatment in a hospital until the C-diff is resolved. Terrible situation that you nurses have to change the pt during dialysis with all the other patients subjected to the aroma & risk for infection.

[anurseadvocate]

I certainly agree with 1214RN. If the patient is that ill that she has such diarrhea then she probably needs treatment and the c-diff might not be colonized but active (infection).???? C-diff is dangerous and can be deadly as you all know, and therefore, very, very strick infection control practices must be implemented. This could spread through your dialysis facility in a flash. I, also, do not see the SNF staff coming to change the patient and have never heard of SNF staff doing that. I have seen, dialysis staff change patients and as the other nurse stated, if it interfers such with treatment it is discontinued. Wonder if the SNF is actively treating this patient..