clostridium difficile

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re: article about c.diff

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hi, in december 06 i was asked to set up an isolation facility at a hospital in the uk for the treatment of patients who have acquired c-diff. this is a world wide growing problem and patients are much sicker and many die from the 027 resistant strain. i would love to hear from any one who has experience of nursing patients with this condition. i am interested in protein/albumin loss and replacement therapies. i am having difficulty comming to terms with losing so many of my patients.

hello, i can see where you're coming from. it's been a major problem in our hospital too where wards were actually being closed because of this ongoing issue.

i work in an isolation ward and most patients we are getting now are elderly patients infected w/ c. difficile. as the source, they acquire the infection from the community, staying too long in the hospital or most often as a result of antibiotic therapy.

our patients are often being managed by iv fluid replacement, with their bloods monitored for electrolyte losses. in our hospital, they are being treated by oral metronidazole 400 mg tds for 10 days( as it is a gut problem, it is best treated that way) if there are no improvements noted, oral vancomycin is prescribed qds (500 mg iv vanc dilluted w/ 10 mls of water for injection, then we give 2.5 mls/dose orally) they are put on stool and fluid charts of course to monitor their progress.

most of the patients do respond on this treatment regime (thank god we haven't lost any of them yet!)once c. diff is diagnosed, stool samples can only be sent again after 28 days to check if they have responded well to treatment.

proper isolation precautions (apron and gloves) and handwashing technique are very important which must be emphasized to all the staff, patients and visitors

hope this helps.

thanks, i note you are also from the uk. we stopped using metronidazole as this was having no effect on the 027 strain. we also do not use vancomycin via the iv route, it is always given orally. our patients are all very ill when they acquire c-diff with multiple co-morbidity. if you havn't this strain yet at your hospital, look out it's a killer.

jj

thanks, i note you are also from the uk. we stopped using metronidazole as this was having no effect on the 027 strain. we also do not use vancomycin via the iv route, it is always given orally. our patients are all very ill when they acquire c-diff with multiple co-morbidity. if you havn't this strain yet at your hospital, look out it's a killer.

jj

Fortunately not ... they do well with oral metronidazole and oral vanc though (don't you use the IV preparation but given orally?) I yet have to discuss that with our ward manager if she knew about the 027 strain. Thanks for the update!

which area do you come from, i'm from the midlands. c-diff 027 is now international, keep in touch if you need any info.

jj

South East - Hampshire

did you say you worked in isolation, what conditions do you care for? this is an area i am very into. love it and want to know more!

jj

I work in IDU (Infectious Diseases Unit), basically most cases that need isolation and/or barrier nursing. There is an isolation risk assessmen,t a certain score before a patient is classified needing an IDU bed, but unfortunately we are not being used properly at the moment " a bed is a bed" as they say.

Patients w/ D&V,C. diff,MRSA,HIV,TB etc.. etc ... neutropaenic patients and CFs for reverse isolation

i think i must be very lucky, i have been able to keep my unit just for c-diff, they may have other infections as well as, such as mrsa and esbl. i have been able to keep my 11 empty beds. they will not be used as 'BEDS' how do you stand with complaints? how do you get away with nursing a none infected patient in an isolation unit? your patients who are neutropaenic must be at risk, or do you have different staff. what is your staff ratio?

jj

i think i must be very lucky, i have been able to keep my unit just for c-diff, they may have other infections as well as, such as mrsa and esbl. i have been able to keep my 11 empty beds. they will not be used as 'BEDS' how do you stand with complaints? how do you get away with nursing a none infected patient in an isolation unit? your patients who are neutropaenic must be at risk, or do you have different staff. what is your staff ratio?

jj

We used to have 12 beds, then 1 was taken away from us. So it's kinda like 1:6 , we have 4 (2 trained and 2 NA's) to do the early , 3 (2 trained and 1 NA) to do the late and 2( 2 trained) to do the night. Our hospital staffing is totally appalling at the moment that one of us is often borrowed by other wards and this happens almost every day. I was even asked 1 night to take charge of a ward with 18 patients and with me was an agency nurse and an HCA. It was our very first time to work in that ward, talking about working in an unfamiliar environment! Anyway we did get through fine, but that was just totally unsafe. We were not properly orientated where things were.... it's really sad but I guess that's pretty much the same with most NHS hospitals nowadays. There's just too much pressure on us nurses.

Now back to infection control, unfortunately you just can't argue with the night managers.