C-diff

[Inquisitive one]

Just wondering how C-diff is handled regarding precautions in other facilities. If the infected resident is in a semiprivate room, are all residents allowed to use the bathroom? Also, what disinfectant product are you using? Does the infected resident who has been treated come off precautions if asymptomatic or is another stool spec sent?

[Blee O'Myacin, BSN, RN]

Just wondering how C-diff is handled regarding precautions in other facilities. If the infected resident is in a semiprivate room, are all residents allowed to use the bathroom? Also, what disinfectant product are you using? Does the infected resident who has been treated come off precautions if asymptomatic or is another stool spec sent?

On my unit, every one is on isolation because of their immune status. But a person with C.Diff should not be sharing a bathroom with a non infected person until the stool comes back negative for the antigens (A & B). Sharing of the bathroom includes the sink and shower since fecal matter can be left there too (on faucets, etc.) I'd also take care to disinfect doorknobs, etc. If possible, C.diff patients should be cohorted together - at the very least.

The infected person should be on flagyl and no immodium or other antidiarrheals.

Hope this helps!

Blee

[peds4now, RN]

I'm very confused about c-diff (RN student here). First, I assume it is Clostridium difficile, but I have also heard of Campylobacter difficile. So which is it? If it is Clostridium difficile, it is normal flora in the large intestine according to my microbiology text. It causes serious problems in the immunocompromised and those on heavy duty antibiotics (an overlappying population...). BUT, for the average, healthy healthcare worker it should not pose a big problem, since it will not overgrow in your intestine unless the other bacteria are wiped out. So my question is, I understand other patients must be protected, and OF COURSE it is disgusting to think of anything passing via fecal-oral route, but why do nurses treat C.diff. like the plague in my facility? AND, when MDs give a frail, elderly person an antibiotic, why don't they take measures to help preserve the natural flora in the intestine?

Just wondering where the science is behind the practice.

[jaimemds]

My facility makes it a practice to give yogurt at least BID w/anyone on ATB's. If they will not eat it, we have the MD order acidophillus QID. We also have the person with C-diff use a BSC. A word of caution though, alcohol hand wash DOES NOT kill the c-diff spore, soap and water must be used. C-diff is very contagious, but standard precautions are usually effective in preventing the spread of infx.

[Drysolong]

I'm very confused about c-diff (RN student here). First, I assume it is Clostridium difficile, but I have also heard of Campylobacter difficile. So which is it? If it is Clostridium difficile, it is normal flora in the large intestine according to my microbiology text. It causes serious problems in the immunocompromised and those on heavy duty antibiotics (an overlappying population...). BUT, for the average, healthy healthcare worker it should not pose a big problem, since it will not overgrow in your intestine unless the other bacteria are wiped out. So my question is, I understand other patients must be protected, and OF COURSE it is disgusting to think of anything passing via fecal-oral route, but why do nurses treat C.diff. like the plague in my facility? AND, when MDs give a frail, elderly person an antibiotic, why don't they take measures to help preserve the natural flora in the intestine?

Just wondering where the science is behind the practice.

I am hoping someone will respond to your question. I'm interested in the answer too. I agree with you, I think C-Diff refers to Clostridium Difficile

[peds4now, RN]

jaimemds, ty for your reply. I looked on cdc.gov too. It did NOT mention that alcohol gel will not kill C. diff, but that is important to know and would explain some of the "hyper" response to C.diff. I'm going to research that further and use soap and water in the meantime! It still sounds like standard precautions should be good enough for anyone who is not especially immunocompromised. CDC does say that most healthy people do no contract disease from C. diff, which makes sense because it is normal flora. The other day a woman on my unit was starting vancomycin and I discussed adding yogurt w/live cultures to her meals and called Dietary to do so. The "real" RNs (I'm a student) looked at me funny, and the person in dietary (probably just a unit secretary not a nutritionist I hope) actually questioned it and said, "won't that just give her diarrhea?" I think it is great your facility tries to stop problems before they start- it seems like such a simple, common-sense approach!

[CaseManager1947]

I am a nurse who also happens to have RA -- I take Remicade for my arthritis, and recently got a severe URI, and was put on some new broad spectrum, and you guessed it... got C Diff. I gotta tell you all, I never, repeat never want to go thru that again. I talked with the ER doctor who treated me, and she said good handwashing vigorously with soap and hot water, spray down the stool with spray disinfectant, and everyone else shouldn't have to be concerned. I was worried, cuz I had two of my grandkids visiting, but she reminded me this illness is most likely to affect those that are debilitated or immunocompromised. At our hospital, all are isolated if they have C Diff + culture and toxin assay. I had to stay off work till I'd been on Flagyl 5 days, and I can assure you, I didn't feel like it anyway. Awful just awful!!

[leslie :-D]

i know of a ltc facility that gives acidophillis for those w/c-diff: it allegedly preserves their intestinal flora.

also, when a pt had c-diff, they weren't moved to another room.

housekeeping was notified, and had their protocols in regards to disinfectants, pts laundry, pts' linens, etc.

they also were meticulous in scrubbing down shared bathrooms, more than usual.

leslie

[stine75]

I am a trainee CNA working at a LTC facility. Today one of the guys planted a big fat smooch on me when I wasn't prepared for it, and afterwards I was told he has c-diff. Should I be worried???

Christina

[CapeCodMermaid, RN]

We try to give anyone at my facility who is on an antibiotic either yogurt or acidophilus. The person with the CDiff should be taught how to wash their hands with soap and water. We cohort anyone we can and never put a compromised person or a fresh postop with some one who has cdiff.

Once the person has completed the antibiotic and has no more diarrhea, they can come off precautions. ..we used to have to get 3 negative stools but now we are getting smarter.