C-Diff and commode disinfection

[momandstudent]

Hello, I need advice. I am the infection control nurse at a LTC facility. We have a pt. that we have moved to a private room months ago r/t c-diff. This private room does share a bathroom. Anyways, we do not have a policy (which I now to need to get completed and in place) for proper disinfection of the commode that the pt. with C-diff uses. So here is the problem: Pt. with C-diff uses the commode and pt. without uses the shared bathroom. The aides had asked me early in the game how to empty the commode. I looked at the whole picture and felt transporting the commode or even the covered commode bucket down the hall, to the utility room to be disposed and disinfected was possibly a huge risk to many other people: other pts, visitors and potentially staff. Oh, and we keep our clean commodes in our hopper room (not because we want to but that's the only space we have). So I told the aides to empty the commode in the bathroom and bleach down the toilet and sink and fixtures after doing so. And yes, I did think about the "toilet spray" effect. The other pt. who shares the bathroom has had no S/Sx of C-diff at all. The question, after months of completing it this way, has been raised. I have looked through APIC and all other infection control manuals, policies and web pages. There is nothing out there. I am now looking for flushable commode liners and am unable to locate anything. I need expert advice. I have looked at all possibilities and I know what we are practicing is possibly putting someone else at risk but if we were to take it through the hall, that would put more at risk. And the pt. who does not have C-diff will not use a commode-she insists on using the toilet in the shared bathroom. This posting is very poorly written and I'm sorry...long day, lots of brain activity and lack of sleep.

[MunoRN, RN]

Has this patient's C-diff infection gone untreated this whole time?

[morte, LPN, LVN]

I have only seen this handled in a semiprivate, which, I suppose, is actually what you have sort of. and that would be the UNINFECTED person must use commode. since he/she won't, you need to change rooms.

[xoemmylouox, ASN, RN]

I understand why the uninflected person does not want to use the commode, but yuck! I'd rather do that than get CDiff. I assume that the Infected person is being treated, but as usual the CDiff just won't clear? That is a tough one.. I say that you have to move one of them. Have the uninflected person switch rooms with someone who already uses the commode? Ensure nothing else of theirs is in that bathroom.

[amoLucia]

They used to have melt-able laundry bags for isolation laundry some years ago. They could just toss the bag into the facility's washing machines so staff didn't have to handle iso linens. Haven't seen them in a while though.

[ClearBlueOctoberSky]

They used to have melt-able laundry bags for isolation laundry some years ago. They could just toss the bag into the facility's washing machines so staff didn't have to handle iso linens. Haven't seen them in a while though.

Sugar bags. We still have them, however wouldn't work in a commode, since they dissolve with any moisture, even wet hands.

[momandstudent]

Thank you for all the input. This pt. was moved to a private setting as soon as we "thought" it may be C-Diff. In our facility, we do not have the availability of moving pts. around easily. So far, while I have been in this position, we have at least been able to move those with C. diff to private rooms (even if they have to share a bathroom). This resident was treated with C. Diff from the beginning but has had multiple bouts. One time, the NP ordered a sample just a few days after she completed one of the treatment rounds. I strive for waiting at least 10 days after treatment to run another stool sample to decrease the chance of false-positives (which I think may have happened one of the times). She then also had a very bad UTI (of course she had recently completed her 2nd round of treatment for C. Diff) and of course-C. Diff AGAIN. This has been one of my major projects this week-to look at and develop a policy for commode use/emptying and disinfecting. We did some science experiments yesterday and came up with our plan and everyone appears happy with it. Now, the question was raised by the DON: What are we going to do when we all of our rooms are full (no available private rooms) and we have a resident, who resides in a semi-private room, gets C-Diff. So the research continues......Again, thank you for all of your input.

[doppelganger2]

This is more in response to the resident having the recurrent cdiff. Are they on any kind of probiotic (lactinex or acidophilus) even activia? When you are checking their stool for cdiff, are they actively having loose liquid stools?

If it's been months of cycling with cdiff, potentially this patient child be a carrier of cdiff. And with abx so frequently, with no input of good bacteria the cycle will continue to repeat itself.

As far as the procedure for semi private room sharing/bathroom sharing with a cdiff pt it's going to be diligent hand washing and loving bleach to sanitize everything.

[MunoRN, RN]

Proper treatment, rather than long term isolation precautions, should be the main way of dealing with this. According to UpToDate, proper treatment of C-diff with oral Vanco is 98% effective in the first round of antibiotics, if multiple rounds fail, a fecal transplant is an option, although one many patients may not be willing to get. But still, it should actually be fairly rare for treatment to fail (vanco or flagyl and flora replacement).

It's important to remember that a positive antigen after treatment does not indicate a current infection, I've seen many MD's not be aware of this, so there may be an issue with how the tests are being understood.

[sapphire18]

Put the commode in a large trashbag to transport down the hall (maybe double-bag). Also...clean BSCs in a dirty utility/hopper room seems unacceptable- they should be cleaned after removal from that room.

[amoLucia]

Sugar bags. We still have them, however wouldn't work in a commode, since they dissolve with any moisture, even wet hands.

Thank you for the reminder - didn't think about the 'wet'. Maybe that provider company offers something else in their inventory that meets the need?

To OP - you might have to consider cohorting residents if nec. We always seemed to have multiple pts with C-diff at any one time. On rare occasions, I seem to remember moving a C-differ in with a pt who couldn't use the BR.

Re the ongoing infection while that pt was using the commode, how was s/he washing hands??? Could it be a case of continued fecal-oral RE-contamination?

[Loo17]

When I worked LTC and there was a shared bathroom situation, the c-diff patient used the bathroom and the clean patient used the commode. The clean patient should be told she has to use the commode for infection control issues if switching rooms is not an option.