C diff in the home

[Nurse Leigh]

I am primary caregiver for a family member who has several comorbidities. She's had a couple bouts of c. diff and I think we've got another episode going now.

I'll be coordinating with her HCPs to see what tests/treatments are wanted.

In the meantime, I've been confused about the best way to disinfect soiled/contaminated surfaces in the home.

In the hospital we used the special wipes which I believe were chlorine bleach based as the alcohol based wipes are useless against c. diff as we know.

I come to you, HH nurses, for some idea of what you recommend your affected patient/families use to clean their environments.

A chlorine bleach dilution seems obvious but I can't find which ratio is recommended or how long it needs to sit and kill. The CDC has some information but is geared towards disinfection on healthcare facilities, not the home, and they are kinda vague on WHICH products are best.

When c. diff is diagnosed or a strong possibility I wash linens and gowns in the machine with bleach but I am not sure I'm using enough.

So different from working in a hospital, especially as here I am a relative/caregiver who also happens to be a nurse.

Thanks for taking the time to read and for any suggestions ypu may have. Also thanks for all you do - HH requires such a breadth of knowledge, and the ability to make decisions with few resources to fall back on. :thumbup:

[vintagemother, BSN, CNA, LVN, RN]

I'm not a home health nurse, but do have experience working in nursing homes where noro and c diff were around.

I found this link online that tells how to kill the c diff and prevent the spread.

http://www.azdhs.gov/phs/oids/hai/documents/HAIcommittee/cdiff-living-with-pamphlet-general.pdf

Ref pages 12-13 for c diff in the home.

Basically it says to treat it with the same contact precautions you'd use for pink eye, lie not sharing towels or wash cloths and to use a 1:10 bleach : water mixture made daily to kill it. Let the bleach air dry on surfaces.

Furthermore, I read many years ago that purple grape juice (or wine [emoji3]) consumption can help to prevent it from colonizing in the gut. In my own experience, I was incidentally drinking 1 glass of wine per night and was the only person in my home who didn't contract the diarrhea. But I was exposed to it at work. I do think I brought it home. Even if I didn't, everyone else was infected (my sons, mom, both grandparents and an uncle) My son was the carrier between 2 houses....

I also stopped wearing my work shoes into the house and used cavicide wipes to clean them before coming home.

[needlesmcgeeRN, ASN, RN]

Cavicide - are those the wipes you're not supposed to use bare-handed?

[vintagemother, BSN, CNA, LVN, RN]

It is quite likely that you aren't supposed to use them bare handed. If you are concerned, don gloves.

I keep a case of Costco medical vinyl gloves at home. I bought them when I worked for a facility that did not provide gloves on all shifts....[emoji40]

[Nurse Leigh]

It is quite likely that you aren't supposed to use them bare handed. If you are concerned, don gloves.

I keep a case of Costco medical vinyl gloves at home. I bought them when I worked for a facility that did not provide gloves on all shifts....[emoji40]

Yep...I remember being warned not to use the wipes without gloves in the hospital - something about liver damage?

I always wear gloves when doing personal care like that. Sometimes we can get decent deals on allegro medical. I think disposable gloves are indispensable.

I'm no germaphobe but I feel better wearing them when cleaning with caustic cleansers and picking up after the dog (older and occasionally incontinent)

[KatieMI, BSN, MSN, RN]

About 50% of us have C. Diff. living happily in our bowels as part of flora, including toxygenic varieties.

C.diff. colitis is NOT a contagious disease like, say, cholera. It is, essentially, disbacteriosis, the result of killing of bulk of other bacteria and letting more resistant ones like C.diff. to proliferate in excessive amount. A person with healthy immune system, normal gastric pH of 1.5 and normal bowel flora can literally eat culture of C. diff. and expect no harm. In hospitals, where the wast majority of patients are sick and receive "GI prophylaxis" (which moves gastric pH to the realm of 3.5 and up) and powerful antibiotics, we need to isolate C. Diff. carriers so that others just such susceptible people would not be infected. At home, isolation, bleach and such make sense only if there are other highly susceptible people are around. For caregivers, hand washing and not going to work wearing the same clothes as ones used during care giving to the patient is enough. "Susceptible" people may be defined as chronically critically sick (home O2, CHF stage III and below, dialysis, chronic complicated diabetes, chronic wounds, malnutrition, current or recent chemo, "extremes of life"( newborns, elderly over 85, pregnant) AND currently or within last 6 months treated with wide spectrum antibiotics AND currently receiving h2 histamine inhibitors and/or proton pump inhibitors for whatever reason. Everybody else should be safe, without living 24 hours in house filled with chlorine fumes.