Taking care of patient with C.Diff?

[citylights89]

I just started Med-Surg I and my first clinical day for the semester is tomorrow. I went today to pick out a patient and asked the young nurse at the desk for any suggestions. She suggested an elderly guy that is on isolation and has contact precautions because of a recent diagnosis of C.Diff. I went ahead and accepted it because she said he was really nice and figuring it would give me a good learning experience. Thing is that I never performed any precaution measures besides the standard precautions.

Now after delving in a little more to how dangerous C.Diff actually can be, I'm scared. There's going to be a lot of gowning, gloving, masking, and hand washing going on. What about my shoes? What about everything else in the room? This is only my second semester in clinicals. I have enough health problems as it is; all I need is C.Diff. Geez, what did I get myself into? :uhoh21: I know it comes with the territory, but I'm scared being a baby student nurse. I should've never said "yes."

[THELIVINGWORST, ASN, RN]

also fyi c diff is part of most peoples normal flora in the intestines. you are FINE :)

only need to worry if you are immunocompromised or on antibiotics

[Clovery]

This past semester I had a patient who was 500 lbs, couldn't even roll to the side without assistance, and had C. diff. He was stuck on our floor for the entire rotation so I ended up taking care of him or assisting other students most weeks.

You don't want to take off your gown or gloves before you leave the room. Like others have said there will be a cart with everything you need and a trashcan next to it right outside the door. I asked my instructor about the need to wash with soap and water and she said after taking off the gown and gloves, use the alcohol sanitizer and go directly to a sink. I left my shoes in the garage when I came home from the hospital and put them in the washing machine. I would also go directly to the shower. If you're healthy you won't contract C. diff. but if you're really worried, take some probiotics or eat lots of yogurt - they can't colonize your intestines when the "healthy bacteria" are in there (that's why people get C. diff when they're on antibiotics - the drugs kill off the healthy, normal flora living in the gut).

Some other things to consider with contact precautions: Don't take anything into the room that you want to bring out. The patient should have a dynamap in the room with them that stays there. There should be a stethoscope hanging on the wall. You might have to do without a penlight. You're going to have to remember your vitals & assessment because you can't write anything down and walk out of the room with it. If you really need to write something - sacrifice a pen to the room (or borrow the patient's) and bring in some tape and paper. Write down what you need to then tape it somewhere inside the room that you can see from the doorway, then copy it down on your notepad once you're out and remove your note the next time you go in. Just be sure it's not somewhere obvious that anyone walking by would see it - that might be a HIPAA violation.

C. diff smells especially bad so grab a bottle of that no odor spray from the supply room. Your patient will also probably appreciate wet wipes since they're having frequent, irritating stools. Some hospitals just have baby wipes but I've also seen adult flushable butt wipes. They will be red and raw in a day or so if you're cleaning them with a washcloth. If the patient is incontinent, moisture barrier cream (essentially diaper rash cream) will help prevent irritation too. Rectal tubes help, but there's usually still a lot of leakage so don't assume the patient is clean and dry just because there's drainage in the bag. If you notice the stool is thick and not watery, you might want to let the nurse or your instructor know - unfortunately I learned by experience that once the stool thickens up, it might push the rectal tube out.

[psu_213, BSN, RN]

I made it through the day. Hopefully, I don't have something that I don't realize yet. I had gas earlier and had to use the restroom 2x today (TIM, I know) and I got paranoid. I'm ok right now with no cramps or anything else like that. Better stay like that!

Yes, TMI, lol.

Take a deep breath (though not in the pt's room...that would be really yucky smelling).

With the proper precautions, C diff is not easy to contract--if I were they would be on a higher level of isolation. Also remember this: when a person with C diff is discharged they go back out into the world. They might be standing next to you at the supermarket (may have even just touched the head a cabbage you are about to buy). They may be the teller at the bank who just handed you money. Etc. Etc. Now I am not trying to freak you or anyone else out, but C diff, like other antibiotic resistant bacteria, are everywhere. My guess is that, if you followed proper precautions, are more likely to be colonized with C diff when out in the regular world than you were taking care of that pt.

[FORTHELOVEOF!!!!]

Use contact procautions correctly and wash your hands, if you follow this you will not contract C-diff. Most people who get this are on antibiotics or are immunocompromised. The big deal about C-diff is making sure you don't spread it to other patients because they are immunocompromised!

[jeffrey_rn]

There was ONE time that I had a C. dif patient on GoLightly....

This is THE definition of a nurse's worst nightmare!

[Scarlettz, BSN, RN]

Isolation precautions get easier with time. I felt like I had an isolation patient every week at one facility I rotated. Mostly MRSA, but I have had two C.Diff patients.

I was always safe, but something frightening did happen to me one time. I was rinsing the comode pan one time when a bit splashed onto my cheek. I don't know if it was water, poo, or a mixture of both. It was a little splat but scary to experience. I washed the cheek with soap and water. If your patient is using a pan or commode or what have you, I would apply some goggles. Luckily I am healthy and I was told later that she was testing negative for C. Diff.

[Jace77]

I just started in a facility and the DON decided we do not need bio-hazard bags in the room. She said we can throw trash and clothing from 6 cdi patients with the regular trash/laundry. To makes it even more of a delight to work here they run out of wash clothes daily, the wipes supply is depleted and many rooms the soap and sanitizer is empty and finding a protective gown is nealy impossible. Have yet to see anyone other than myself wash their hands, I took soap and sanitizer from home with me! The patients doors are always left open for good measure! Needless to say on day 3 of employment I put my 2 week notice in.

[Llawver]

Have you been in isolation at all before? I don't mean to insult you in anyway. I'm just asking because it sounds as though you don't feel comfortable with putting on all the PPE's. I had a patient with c-diff about a month ago and the worst part for me was the smell and the stools. Normally feces don't bother me but c-diff is just raunchy. This gentelman used the bedside commode and couldn't make it from the bed and there was diarhhea literally everywhere. We had to clean him up, completely change and wipe down the bed, clean the bedside commode. It was awful. Funny you should bring up the shoes because I had feces all over mine. Fortunately, I keep an extra pair of scrubs in shoes in my car at all times. I placed the shoes in a bag and literally soaked them in a bucket of straight bleach on my porch for about two days.

Anyway, here is my advice. Keep a change of scrubs and shoes in your car with you on clinicals. This is a good idea anyway even if your not in isolation. Grab a few extra pairs of gloves and keep them in your pockets. You never know when you might get into a sticky situation, especially in isolation and with c-diff. All the ppe's should be near the door so you can get em on before you interact with the patient. All of the equipment should be in the room as well. Depending on the hospital you may have a dynatec. There should also be a stethoscope...they aren't the greatest, kind of like the ones you can buy at Wal-Mart. Take the wipes with the yellow lid to wipe down the equipment when your finished but make absolutely sure you don't shed those gloves until you are finished touching everything. I removed my watch with c-diff just because it could easily get contaminated. Last, and perhaps most important, be sure to wash your hands thouroughly with soap and water after you shed your gloves because hand sanitizer does NOT kill c-diff.

[Anoetos, BSN, RN]

Claustridium difficile is part of your normal intestinal flora. It becomes a problem for the immune suppressed or those undergoing treatment with broad spectrum antibiotics since these dramatically alter the competition for resources in the gut. This is why one rare, but evidently effective treatment involves the reintroduction of bacterially balanced fecal matter into the lower GI of symptomatic patients.

For the person with a normal immune system, C. diff should cause no problems. We take the precautions we do with it less to protect ourselves than to protect our other patients. The same is actually true of nearly all of those superbugs we used to call nosocomial but now refer to as hospital acquired.

Believe me, if C. diff were something people with working immune systems could become infected by, RNs would never be off the toilet judging by the compliance with precautions I see in most hospitals.