C Diff

Thread moved to LTC Nursing forum.

Hi Everyone; New here. Huge debate at my facility regarding C Diff. We do not have an "Infection Control Nurse" at this time. The setting is a SNF; great rehab facility. Here's my dilemma. I always thought that in a room with two patients; that the person with the cdiff uses the bathroom and the person without the cdiff uses a commode. I searched the medicare quidelines and can only find to use a private room or co-habitat. Please clarify. Your help is greatly appreciated.

Vanessa

Hi Vanessa -

Think of it this way. A person with C.Diff uses the toilet. Then they forget to wash up afterwards and touch the doorknob to the bathroom and the wall and the doorknob of the room, etc. The risks of having the roommate contract C.Diff are significant, just with contact of the shared items in the room. Add to it the humiliation factor of a long term care resident having to use a adult sized potty (for all intents and purposes, it's a potty). Its just asking for trouble. Policy where I work is that C.Diff positive patients are cohorted or put in a private room.

Hope this helps!

Blee

We give the C-diff positive a private room or cohort with another c-diff positive. I don't think it is worth the risk of them sharing a room with another resident.

I worked in one facility that put a resident with cdiff in isolation that seemed a little bizarre to me masked up gowned up the works. Most places that i work they have them on red bag and give them there on commode. On a different note isn't cdiff the most foul smell in the world I can handle bm but that turns my stomach.

A policy should be in place. The CDC guideline should be adhered to. In the absence of a designated staff, the DON or Medical Director should assume responsibility that this policy is complied with.

http://www.cdc.gov/ncidod/dhqp/id_CdiffFAQ_HCP.html

Lack of knowledge of the disease process is indeed costly.

Unless they are admitted with it, we don't move rooms around. Nearly impossible since we have 4 privates and they are always taken. All we do is give them a comode

Because C Dif results in sometimes rather explosive diarrhea, the spores from the bacteria can heavily infect the whole environment. It is not safe to have these patients share a room with another patient, because it's almost impossible for the non-infected patient to avoid the spores from the bacteria. If you find C Dif after admission, the non-infected roomate should be moved to a private room (moving the infected patient won't help because the environment is already contaminated).

Many places put any patient with diarrhea on contact precautions until C dif is either confirmed or ruled out by sending several specimens to lab.

Masks aren't necessary because the spores aren't airborne; it's mostly spread hand-to-mouth. Gowns and gloves, along with strict handwashing and thorough cleaning of the environment post-discharge will protect staff and other patients.

Since you state your facility doesn't have an infection control nurse, you might inform your management that the quaternary disinfectant typically used to clean patient rooms is not effective against C. diff. Only a solution of chlorine bleach will kill the organism (we use 1 part household bleach to 10 parts water).

C-diff is very contagious. I've heard of outbreaks where a patient in a neighboring room was infected because the floor was mopped with the same mop as a (undiagnosed) C-diff patient during daily cleans. In units where this is a substantial risk, we now change mops for every daily, and housewide we put pts in isolation at the first hint of C-diff.

Having an uninfected patient share a room with an infected one seems pretty close to deliberately infecting them--I wonder, though, what the transmission rate actually is. C-diff is opportunistic--I can imagine that a fair number of relatively healthy residents avoid infection--but the practice is still not good.

We have the CDiff person use the toilet. If THEY use the commode, that would mean flushing it in the bathroom or carrying it down the hall to flush elsewhere thereby contaminating everything. The person without CDiff either uses a commode or is offered a bathroom down the hall.

We haven't had anyone contact c-diff in house since I have been there, but we have had a few admissions with it, they were placed in a private room with contact isolation.

OMG! If I had a family member in any facility that contracted C-diff d/t lack of proper isolation and precautions or was made to walk down the hall to another bathroom and endure the smell- I would SUE and WIN. It's totally against the standard of care. I don't care if there isn't room. If that is the case- the person needs to be transferred to where they CAN be in isolation- it's medically necessary if there is no beds at your facility. How horrible!!!!

I'm not sure you can make another pt leave if they have C diff? Doesn't sound right. Hey...we don't have any place to put you...you have c diff. you need to find a new place to live. Uh No. Ain't gonna fly.

The facility needs another policy in place.

I understand what you are trying to say though.