The end of C-diff testing??

Bree124, BSN, RN · Jan 28, 2009

I would think it is a problem, unless your facility doesn't use waterless soap at all. Our c-diff patients have the hand washing magnets on their doors, and I KNOW that most nurses don't wash with soap and water unless they have patients with c-diff...

medicrnohio, RN · Jan 28, 2009

You are not wrong about c-diff being highly contagious. Hands must be washed with soap and water before and after caring for c-diff patients. I can understand that the hospital doesn't want to be dinged for a hospital aquired infection, but this new policy puts everyone at risk. In my hospital, if a patient has diarrhea they are automatically placed in contact precautions and nursing may place a policy/protocol order for c-diff testing.

nerdtonurse?, BSN, RN · Jan 28, 2009

I've been watching at my hospital to see if we start doing something similar, since we know we're due a JC visit. We were told in a meeting that if we get a new admission and their skin looks red (well, crap, my skin would look red if I had to bump down the hall on one of the ER stretchers), you document it as a decubitus, even if it blanches, and if it doesn't, it's an "evolving" stage 2 and should be documented as a stage 2. A stage 2 on intact skin!? A stage 1 on an otherwise healthy 24 year old who's in with R/O appendicitis? That way if that person does get a decube, well, "they came in with it.":banghead:

ChristineN, BSN, RN · Jan 28, 2009

Not testing for C-dif?! That's the stupidist thing I've ever heard. I would doccument "doctor notified pt having runny diarrhea, doctor not wishing to send samples" That way, if the pt is found later on to have C-diff, you will have covered your ass.

eriksoln, BSN, RN · Jan 28, 2009

Not testing for C-dif?! That's the stupidist thing I've ever heard. I would doccument "doctor notified pt having runny diarrhea, doctor not wishing to send samples" That way, if the pt is found later on to have C-diff, you will have covered your ass.

Good advice. I would go a step further too.

Call ID and see if it is true or not. Send the sample anyway, order it yourself.

KyPinkRN · Jan 28, 2009

Wasn't the doc concerned about treating the c-diff... it's hard enough to get rid of the infection, but I would think if it was just ignored it could have dire results for the patient's outcome.

Our hospital is backwards on the contact precautions... the cultures/testing is done if a positive comes back then the patient is placed in contact precautions. I'm not sure why it is, but we were taught in school to consider a patient positive for whatever they were being tested for until it was r/o be it MRSA, c-diff, TB. I can think of an instance recently where a woman was on our floor and wound up having active TB... nobody knew and we cared for her for 3 days... standard precautions. :uhoh3:

Pepperlady · Jan 28, 2009

If the hospital doesn't want to be dinged with a hospital acquired c-diff then they need to ensure proper isolation precautions, not igonore it. What are they going to do when there is an outbreak?? Ignore it?? Cause it isn't going to go away if it is ignored and it is going to cost patients their lives ... c-diff will kill patients, as will MRSA

Spoiled627 · Jan 29, 2009

I've been watching at my hospital to see if we start doing something similar, since we know we're due a JC visit. We were told in a meeting that if we get a new admission and their skin looks red (well, crap, my skin would look red if I had to bump down the hall on one of the ER stretchers), you document it as a decubitus, even if it blanches, and if it doesn't, it's an "evolving" stage 2 and should be documented as a stage 2. A stage 2 on intact skin!? A stage 1 on an otherwise healthy 24 year old who's in with R/O appendicitis? That way if that person does get a decube, well, "they came in with it.":banghead:

I think the reason they do that is because Medicare will not pay for hospital aquired ulcers anymore. I think, it was passed May of 08 but not sure. You might want to look into it.

AmaurosisFugax · Jan 29, 2009

I'm mystified by this, so basically the Drs are ignoring what is causing severe diarrhea? Isn't that gross negligence? Or are they just not recording the dz but giving vanco or metronidazole anyway to be on the safe side but not putting on record it was a nosocomial infection? Sounds really strange.

MedicalLPN, LPN · Jan 29, 2009

That's insane, it's sad that Joint Commission and administration would rather see patients die or suffer complications from untreated C-Diff than to pay for a stool sample and some flagyl.

Jolie, BSN · Jan 29, 2009

This is a perfect example of the dire unintended consequences of a poorly-thought-out decision by Medicare to refuse payment for a sometimes unavoidable complication of hospitalization.

A patient with a likely c-diff infection will not be tested so that the hospital can avoid being "dinged" for a nosocomial infection.

The patient, undiagnosed, will not receive necessary and proper treatment, perhaps resulting in prolonged illness or more serious complications.

The patient, undiagnosed, will not be placed on necessary isolation precautions to avoid contamination of equipment, staff hands and clothing and the room.

Staff, unaware of the need for soap and water hand washing, may transmit c-diff to equipment, clothing, room fixtures, common areas and supplies, other patients and carry c-diff home to family members and the community.

Housekeeping, unaware of the need for terminal cleaning will fail to adequately disinfect the room upon patient discharge or death, exposing the next occupant to c-diff contamination.

A few days after admission, the next patient may begin to have watery diarrhea, and the cycle begins again.

Thanks Medicare!