The end of C-diff testing??

Published

Cared for a woman on nights over the weekend. She had an episode of massive diarrhea (bed, floor,toilet). This was the third night she had diarrhea. Saw her attending Monday morning and I mentioned it to him suggesting we get a stool for C-diff. He told me the hospital wasn't testing anyone for c-diff who'd been hospitalized longer than 48 hours. They don't want it to look hospital acquired.

I'm thinking of a million reasons why this policy is a problem. Does this increase the potential for c-diff spreading to other patients and staff? Since it's a system wide policy, it's a system wide problem now and in the future. Am I wrong about c-diff being so contagious? Any info would be appreciated.

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:

Next, they will have you charting that the pts are all DOA-

That way if a pt dies in the hospital "They came in here dead."

And if they live, the hospital can be credited with bringing the dead back to life.

:rolleyes:

The fact that dead pts are not able to say anything negative on their pt satifaction surveys is another positive to this approach.

:lol2:

Up Vote Up Vote ×
Specializes in ICU, Telemetry.

Wonder when our hospital will start the "what they catch here, stays here" mentality like the OP's hospital...

And Valerie....I like your sense of humor! "Welcome to Resurrection General, where you're not dead unless you died before you were admitted..."

Up Vote Up Vote ×
Specializes in CCU & CTICU.

Lately at my job, they just figure that the pts with diarrhea have CDiff and treat for it, calling it "CDiff prophylaxis." :bugeyes: This is almost always the chronics who have other bugs anyway, so the room is terminally cleaned when they move on. And everyone there is on contact iso to begin with.

If it's a non-chronic pt, then they'll test it.

Up Vote Up Vote ×
Cared for a woman on nights over the weekend. She had an episode of massive diarrhea (bed, floor,toilet). This was the third night she had diarrhea. Saw her attending Monday morning and I mentioned it to him suggesting we get a stool for C-diff. He told me the hospital wasn't testing anyone for c-diff who'd been hospitalized longer than 48 hours. They don't want it to look hospital acquired.

I'm thinking of a million reasons why this policy is a problem. Does this increase the potential for c-diff spreading to other patients and staff? Since it's a system wide policy, it's a system wide problem now and in the future. Am I wrong about c-diff being so contagious? Any info would be appreciated.

I am wondering if the physician has mixed up their tests. Most hospitals will not do stool cultures on patients hospitalized more than 2 days. This is based upon multiple articles that show its not effective such as this one:

http://www.ncbi.nlm.nih.gov/pubmed/11176841?ordinalpos=3&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DefaultReportPanel.Pubmed_RVDocSum

Notice that the article specifically excludes C-dif from the studies that they do not get. If you don't test for C-dif you are faced with two courses of action. One is to ignore it and see the corresponding death rate shoot up. The other is to treat all diarrhea with Flagyl with associated resistance and drug side effects. The more prudent solution would be to test for C-dif. Not really sure what the thinking is. I would check and make sure that the policy is what the physician thinks it is.

David Carpenter, PA-C

Up Vote Up Vote ×

Because we are a psych unit, we don't have those wonderful dispensers outside each room for handwashing. We were instructed we must wash our hand upon entering a patient's room. However, because of some new, unknown JC reg, (I'd like to meet the person who thought this one up) the faucets have no handles, come on by tapping the underside of the spout AND only stay on for about 30 seconds before shutting off. The showers are on for ten minutes and you have to wait another ten minutes for the water to go back on!

We were asked to stop emailing the IC nurse in the past when we had questions about MRSA. I'm sure I'd get called on the carpet if I asked her about c-diff.

The MD was very clear about not testing. Patient could get Immodium 2mg TID PRN. I asked for an increase in the dose and it didn't happen.

Can't send a stool without an order and if this is the policy, I won't be able to sneak an order from the resident.

Some of our patients are street folks and haven't had a bath in forever. Some are too depressed or psychotic to care.

I'm worried about getting it and infecting my family. Also, would be hard to prove I got it at work if we're no longer testing.

Thanks for the responses. Would be interested to know if this is happening at other hospitals. BTW, I work in a large university hospital. Thought they'd be better about taking care of patients and their employees.

Up Vote Up Vote ×

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.

Thanks Medicare!

Look at the bright side. If enough nurses carry c-diff home to family and community, more patients actually will arrive at the hospital with community acquired infx. :uhoh3:

Reimbursement problem sol-ved, as Inspec, er, Chief Inspector Clouseau would say.

Up Vote Up Vote ×
Specializes in Emergency.

This sounds to me like bad practice for a hospital. My hospital is very diligent about c-diff and other potentially contagious and deadly infections. If an MD orders stool samples to rule out c-diff, even if there could be another reasonable explanation for the diarrhea, the patient is automatically placed on contact precautions as per hospital protocol (yes it's a pain in the you-know-what, but better to be safe than sorry!), and when the samples (here its 3 separate stools) come back negative they are taken off contact for the rest of their stay. If it comes back positive, well, we have been proactive in hopefully preventing the spread of a nasty infection.

I think because of a lack of education, lots of people do not realize how bad an infection of this type can be...Last week I had a patient on comfort care (our hospitals palliative care for dying patients) who was dying from septicemia related to a c-diff infection. She was young (70 something) and in a rehab facility for a hip replacement. She somehow acquired the disease, and by the time she got to us she was in septic shock, with nothing we could do but make her comfortable. To a healthy person, MRSA, C-Diff, etc, may be an easy thing to treat, but to an older or very young patient they can be so deadly.

Our ICU now does standard screening for MRSA in all their new admits whether they have an open wound or not (they take a nasal swab). This may seem silly since most of the worlds population probably has MRSA living in their nasal passages, but to be with a patient who has it on them, then go and treat another very sick debilitated patient without proper precautions, and it can have a deadly consequence to that patient. I would be very worried about any hospital that has stopped testing for these infections just because they don't want to pay out for treatment if it is determined to be nosocomial. They are putting peoples lives in danger, and I can't imagine JC and other regulatory boards being OK with that.

As for the poster that discussed her patient with active TB: Here if AFB swabs and PPD testing are ordered, they are automatically on airborne precautions until proven negative (we do not need a MD order to do this, it is hospital protocol), but it has happened on my unit also where the TB was determined after the fact...Scary, and luckily noone working has come up positive.

But you have to remember that as health care workers you come in contact with patients every day who may not have outward signs of infection, so you need to be diligent about standard precautions always. How much are we exposed to that we never know about? What could we pass along to our other patients just by forgetting to sanitize between rooms, much less expose ourselves to by not washing hands or using the sanitizer. I'm all for the philosophy of "human touch" and do not feel like I need to wear gloves or other PPD just to get vitals, etc, but I will always wash my hands between patients and am very careful not to touch my eyes or even rub my nose before washing after contact with any patient. My scrubs come off and go into the wash right after I get home, and I shower right after that to prevent exposure of my family and myself.

It is in my opinion crazy not to test patients just to save money, but if it's your hospitals policy, just watch out for yourself and your patients, and document MD refusal to test.

Amy

Up Vote Up Vote ×
Next, they will have you charting that the pts are all DOA-

That way if a pt dies in the hospital "They came in here dead."

And if they live, the hospital can be credited with bringing the dead back to life.

:rolleyes:

The fact that dead pts are not able to say anything negative on their pt satifaction surveys is another positive to this approach.

:lol2:

:yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2::yeah::lol2:

Up Vote Up Vote ×

Major problems with c-diff here, testing does finally get ordered, but by that time the patient has suffered much, so has other patients in the room, and staff. So short sighted. A couple of times the orders were written by the unit coordinator d/t staff complaints. Waiting to see what develops next.

Up Vote Up Vote ×

Wow, we are so lucky at my hospital. When the first episode of the runs happens we test for c diff and then we test at intervals until the patient is negative. When they have the first attack of the runs they are placed in a side room until we get the results of their tests back. If its positive then they get shipped to the c diff ward and if negative they get shipped back to the main ward when the runs have stopped/solidified a bit :D Im currantly working on our C diff ward.

Up Vote Up Vote ×

Pardon this silly pre-nursing student..... can't you make an anonymous report to the CDC or local Board of Health to get the hospital forced to re-institute C-Diff testing?

Up Vote Up Vote ×
Next, they will have you charting that the pts are all DOA-

That way if a pt dies in the hospital "They came in here dead."

And if they live, the hospital can be credited with bringing the dead back to life.

:rolleyes:

The fact that dead pts are not able to say anything negative on their pt satifaction surveys is another positive to this approach.

:lol2:

This is so funny...hahahahahaha...:yeah:

Up Vote Up Vote ×
+ Join the Discussion