Patient With C-Diff Nursing Care Plan Essay Paper

Clostridium difficile
Pathophysiology
Clostridium difficile is a gram positive, spore forming anaerobic bacillus, which may or may not carry the genes for toxin A-B production (Nipa, 2010). These two types of protein exotoxins produced by the Clostridium difficile bacillus, toxin A and toxin B, can have an infectious form and a non-active, non-infectious form (Grossman, 2010). The infectious form can survive for a short duration of time in the environment. The spores can survive for a longer period of time in the environment and are not infectious unless and until they are ingested or are transformed into an infectious state (Nipa, 2010).Patient With C-Diff Nursing Care Plan Essay Paper

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Treatments Clostridium difficile associated disease will resolve when the patient discontinues taking the antibiotics to which he/she has been previously exposed (Nipa, 2010). Administration of a different antibiotic is used to treat the infection (Grossman, 2010). The infection can usually be treated with an appropriate course of about 10 days of antibiotics including metronidazole or vancomycin administered orally (Nipa, 2010). On occasion intravenous vancomycin may be necessary (Gould, 2010). The nurse should ensure patients are not only taking the newly prescribed antibiotic, but also responding to the treatment by showing a decrease in symptoms. Symptoms can recur despite antibiotic therapy, close monitoring is essential. In order to avoid risk of further complications, nursing interventions would include careful assessment of white blood cell count, temperature, and hydration status; meticulous skin care and assistance with bowel elimination given the loose frequent stools; and management of abdominal discomfort (Grossman, 2010). Patient With C-Diff Nursing Care Plan Essay Paper

Ever since I’ve been working in long-term care facilities and hospitals for almost fourteen years, my multiple encounters with Clostridium difficile become prevalent as the years go by. The incidence of its unprecedented spread has increased dramatically in the past decade. This observation was proven by the recent National and State Healthcare Associated Infections Progress Report, published March, 2014 by Centers for Disease Control and Prevention (CDC) which suggests that C. difficile has replaced methicillin-resistant Staphylococcus aureus as the most common cause of the health-care associated infection, specifically showing the national standardized infection ratio of 0.98 for hospital-onset C. diff infection against 0.96 for MRSA bloodstream infection. The etymology of the rising new “superbug” Clostridium difficile, also known as C. diff is derived from the Greek word klōstēr which means spindle and Latin difficile, “difficult, obstinate”. The genus name, Clostridium is used because under the microscope, the colonies of these bacteria looks like spindles used in cloth weaving and long sticks with a bulge at the end. The species name difficile owing to the fact that when first identified by Hall and O’Toole in 1935 Patient With C-Diff Nursing Care Plan Essay Paper

Clostridium Difficile: A Ruthless Invader
Clostridium difficile (C. difficile) is a pervasive and troublesome bacterium in healthcare. If left untreated it can lead to a plethora of complications—acute, chronic, and even fatal. C. difficile is a gram positive bacillus (with a capsule) and has ideal conditions for growth at around 37°C in an obligate anaerobic environment. In its vegetative state, C. difficile contains multiple flagella for motility within the intestinal tract; 1 however, once outside of its ideal environment, or through active shedding, it’s left latent within its hardy endospore until it is in its ideal environment once again.
Transmission of C. difficile occurs from inadvertent ingestion of endospores through either direct or indirect contact via the fecal-oral route. Humans and animals are both reservoirs for C. difficile, which has brought about new studies with the goal of determining if endospore-contaminated meat products could also be a cause for human infection.3
Among C. difficile, there are a number of virulence factors with varying mechanisms of pathogenicity. Most notably, this bacteria produces 1-3 toxins during a C. difficile infection (CDI): an enterotoxin (toxin A/ TcdA), a cytotoxin (toxin B/ TcdB), and a binary toxin (C. Patient With C-Diff Nursing Care Plan Essay Paper

Historically speaking, people with the bad luck to develop an infection have never had it so good. Modern medicine can deploy a vast array of antibiotics and other tools for their benefit.

For some of them, though, our shiny, state-of-the-art treatment includes a direct carryover from the Middle Ages.

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These are the people who are not just infected on the inside but also infested on the outside, covered with germs. And when they are hospitalized we hustle them into an isolation room, and no matter how much they may protest and complain, and no matter how cumbersome it makes the rest of their medical care, we never let them out.Patient With C-Diff Nursing Care Plan Essay Paper

Isolation must be one of the oldest medical tools, and in some ways it is one of the most brutal. Purists routinely point out that no one has ever definitively proved that it accomplishes its goals any better than, say, assiduous hand washing and the enthusiastic use of bleach. But isolation is probably too primal and entrenched a practice ever to be studied in the usual dispassionate way.

We have at least improved a little on standard 14th-century medical practice by understanding more about how germs behave

So we keep patients with active tuberculosis in rooms specially ventilated, so that in theory, germs do not rush out into the public corridor when the door is opened. All visitors wear tight-fitting masks, but gloves and gowns are unnecessary, as TB does not spread by touch.Patient With C-Diff Nursing Care Plan Essay Paper

Touch does, however, transmit methicillin-resistant staph, or MRSA, and the other antibiotic-resistant bacteria that are the bane of many hospitals these days. In ours, some of the isolation rooms go to people harboring these germs, but most now are occupied by patients with the intestinal infection called C. difficile colitis.

This organism is a spore-former: it makes small, hard seeds that cling to surfaces and parachute all over the place. Patients are, to use the unusually evocative technical terms, covered with a fecal veneer and they move in a fecal cloud.

A microscopic version of Google Earth, scanning them in and out, would show a small, malevolent universe consisting of a human being surrounded by a shimmering, human-shaped cloud of bacteria. When patients turn in bed, giant waves of bacteria rise and travel on air currents all over the room, landing on bedside tables, on adjacent beds and on the people in those beds. The palms of people who touch these patients turn gritty with bacteria, and every time those caring hands touch another patient, the bacteria stick fast.Patient With C-Diff Nursing Care Plan Essay Paper

Our hospital’s current policy for avoiding the resulting outbreaks of infection is typical of most: every patient with diarrhea is isolated until we have proven C. difficile is not causing the problem. Each goes into a private room, with boxes of disposable gloves and gowns by the door, which remains closed.

Aragen Bioscience experts design and manage infectious disease programs that maximize a drug candidate’s probability of success. Our team’s extensive experience results in a thorough understanding infectious disease modelling, allowing our clients to creatively test compound activity, design new delivery mechanisms and explore novel vaccine strategies for a variety of infectious diseases.

Clostridium difficile infection (CDI) can cause symptoms ranging from severe diarrhea to life-threatening inflammations of the colon. Although the infection can usually be controlled with antibiotics, virulent strains of C. difficile are now appearing that resist treatment with common medications.

Established in vivo models of acute as well as relapse of C.difficile infection
Our team is trained and experienced in handling this pathogenic organism
Several dozen in vivo studies have been conducted cumulatively over the last eight years in the areas of therapeutic, prophylactic as well as vaccine models of this disease Patient With C-Diff Nursing Care Plan Essay Paper

RSV infection is the major cause of severe respiratory illness in infants and young children, as well as immune compromised individuals and the elderly. It causes a range of illnesses varying from mild infection to life-threatening bronchiolitis and respiratory failure. Rodent models for testing efficacy and safety in preclinical studies provide a critical component to the development of anti-RSV antibodies, small molecules and vaccines.

We offer both mouse (BALB/c) and cotton rat (Sigmodon hispidus) RSV infection models
A wide range of functional in vivo and ex vivo readouts are available to assess the efficacy of anti-RSV biologics and small molecules
More than 60 pre-clinical studies in rodent models of RSV infection have been performed

Human CMV (hCMV) is a major cause of birth defects in industrialized nations. While usually hCMV infection does not cause major illness in healthy people, it can be life-threatening for immunocompromised persons. Although CMV infection is species-specific, human and mouse CMV share much similarity at the genetic and nucleotide level. Moreover, the mouse CMV (mCMV) infection model shares many characteristics with human disease and can therefore be used to mimic human CMV infection in animals.Patient With C-Diff Nursing Care Plan Essay Paper

Mouse (BALB/c) CMV infection model in normal and immunosuppressed animals
A wide range of functional in vivo and ex vivo readouts are available to assess the efficacy of anti-CMV therapeutics

These gowns are thick yellow paper smocks individually wrapped in plastic, with cotton-knit cuffs and ties that wrap around the waist. The gloves are standard-issue vinyl, packed into boxes of S, M and L. Putting on the gloves and gowns takes a couple of minutes (unless the supplies are missing or we are down to the ridiculously tiny size S gloves, in which case the search for replacements can go on quite a while).

Clostridium difficile (aka. “C. diff”) is a spore-forming bacteria that’s very hard to kill. As C. diff becomes increasingly worrisome for hospital patients and infectious disease experts, what does the general public need to know?Patient With C-Diff Nursing Care Plan Essay Paper

1. C. diff infections are becoming more common and more severe. A recent study funded by the United States Centers for Disease Control and Prevention (CDC) estimated that there are 453,000 infections in the United States per year and 29,300 deaths within 30 days after the initial diagnosis. The infection will recur in an average of 20% of people infected. Almost half of the infections occur in people under 65, but more than 90% of the deaths occur in people 65 and older.

When the United States Centers for Disease Control and Prevention (CDC) issued its major report Antibiotic resistance threats in the United States, 2013, there were only 3 bacteria concerning enough to be classified as “Urgent” threats. C. diff was one of them.

Since the year 2000, not only have the number of cases doubled, but there has also been particular concern about a strain referred to by its genetic type, North American Pulsed Field type 1 (aka. “NAP1”). NAP1 has spread widely since it was first found responsible for outbreaks in Pittsburgh (2000), Atlanta (2001-2), and Montreal (2003). NAP1 is believed to be making people sicker because of its production of extra toxins; it makes more of C. diff’s usual endotoxins A and B, but also makes an extra toxin called “binary toxin.”Patient With C-Diff Nursing Care Plan Essay Paper

The result of all these toxins being dumped into the intestines is a diarrheal illness that can become much more serious than simple diarrhea. What begin as damaged patches on the lining of the intestinal wall can lead to more serious conditions like perforations of the colon, pseudomembranous colitis (PMC), toxic megacolon, and bloodstream infections (aka “sepsis”).

In the new Consumer Reports rankings about infection risks in U.S. Hospitals, rates of C. Diff infections were included in the scoring. Over 70% of C. diff cases are in association with healthcare facilities.

2. High C. diff rates in a facility are an indicator that antibiotics are being overused, and that the facility may be a breeding ground for other drug-resistant infections.

C. diff infections usually happen to people who are given antibiotics. The CDC estimates that up to 30-50% of the antibiotics prescribed in hospitals in the United States are unnecessary or inappropriate, and this leads to a lot of unnecessary C. diff infections.Patient With C-Diff Nursing Care Plan Essay Paper

Antibiotic-associated diarrhea (AAD) can be a common and usually temporary inconvenience of antibiotic use. We have a lot of beneficial bacteria in our gut that usually help us battle the bacteria that can give us diarrhea. Antibiotics tend to kill all bacteria indiscriminately, temporarily leaving our gut vulnerable to diarrhea-causing bacteria without good bacteria there to mount a defense.

C. diff causes about 15-25% of AAD, and about 20% of patients with C. diff will resolve their infection within 2-3 days of stopping the antibiotic that is contributing to the problem. The other 80% may need yet more antibiotics specifically to treat the C. diff infection.

Often, the drug being used to treat C. Diff infections is a powerful antibiotic called vancomycin. The CDC is concerned that all of this vancomycin use is fueling vancomycin resistance in other bacteria, specifically the genus Enterococcus. Because of the emergence of so many vancomycin-resistant enterococcus (VRE) infections in the healthcare setting, the CDC currently recommends treatment first with the drug metronidazole, reserving vancomycin for C. diff infections that do not respond.

C. diff reduction hinges on prescribing antibiotics correctly. This means prescribing the correct antibiotic for any type of bacterial infection, and only using antibiotics when necessary. This is called “antimicrobial stewardship,” a multidisciplinary approach with physicians, infection control practitioners and pharmacists to target a specific infection by using a specific drug. Consumer Reports found that one of the common features of the top-performing hospitals is an antimicrobial stewardship program.Patient With C-Diff Nursing Care Plan Essay Paper

3. High C. diff rates are an indicator that the the surfaces in the facility may be dirty.

C. diff is difficult to kill on surfaces. Many hospital disinfectants don’t kill C. diff because it has a protective shell around it and can survive on surfaces for months in a “spore” form. This makes it more difficult to kill than other bacteria or viruses, and special EPA-approved cleaning agents must be used. The most cost-effective and common of these is chlorine bleach. By default, if C. diff has been killed, almost all other germs found on hospital surfaces have also been killed.

If healthcare providers, food handlers, visitors and patients are regularly touching contaminated surfaces and then touching things that could contaminate the patient’s environment, hands, or the patient’s food, the likelihood is increased that a patient will ingest C. diff.Patient With C-Diff Nursing Care Plan Essay Paper

4. High C. diff rates are a good indicator that hand hygiene and isolation precautions are not taken seriously in a healthcare facility.

In healthcare facilities, patients with infectious diarrhea (or other germs that tend to move around on caregivers’ clothes and hands) should be placed on an isolation precaution called contact isolation.

For patients on contact isolation, providers are supposed to wear gloves and special disposable gowns before touching the patient or anything in the patient’s environment. Those gloves and gowns are then thrown away before leaving the room so that infections are not transferred room-to-room, patient-to-patient.

Hand hygiene before and after patient care is always important, but with C. diff, hand hygiene is special. Hand sanitizers do not kill C. diff. The recommendation is to wash the spores away with soap and water, but the CDC calls glove use “the cornerstone for preventing Clostridium difficile transmission via the hands of healthcare workers.” This is because some studies have shown that even soap and water do not do a good job of removing C. diff spores, with one recent study showing the use of a friction agent (sand) to be more helpful in sanitizing hands that have been in contact with C. diff.

5. You don’t need to be in a hospital to get C. diff.

Between 2000 and 2010, incidence of C. diff among non-pregnant adults doubled. Over 70% of these adults had an overnight stay in the hospital, but the remainder of the cases were community-acquired. Although nursing home residents and hospital inpatients remain the highest-risk groups, C. diff infections have become more common in groups not previously associated with C. diff infections, such as pregnant women and kids. Patient With C-Diff Nursing Care Plan Essay Paper

Recommendations for HealthCare Providers

-Before treating infections with any antibiotics, research current treatment guidelines, available at the CDC website. Ask yourself, “Is this antibiotic truly clinically necessary, or can this infection (like many of the food borne infections) clear on its own?”

-If treating empirically with broad-spectrum antibiotics (based on symptoms, not culture results), assess whether the antibiotic is appropriate once cultures and sensitivities become available.

-Be aware that the antibiotic classes that most often lead to C. diff infections are the drug classes called the fluoroquinolones, broad-spectrum cephalosporins and penicillins, and the drug clindamycin.

-Be aware of the current resistance patterns within your facility (aka. an “antibiogram”) and within your community.

-If you suspect C. diff in your patient, order tests for C. diff toxin, isolate in C. diff precautions, and follow the widely-accepted treatment guidelines by the American College of Gastroenterology, found here.

-Model good behavior by using gowns, gloves, and washing your hands.Patient With C-Diff Nursing Care Plan Essay Paper

More information about C. diff for providers can also be found here.

More information about antibiotic use can be found here.

Recommendations for Patients

-Talk to your doctor about whether an antibiotic is really necessary. If your doctor thinks they are truly needed, take them exactly as prescribed and take them until they are gone.

-Realize that hospitals have a lot of very dangerous germs, and they usually travel via the hands of healthcare providers. Ask healthcare providers to let you see them wash their hands before they touch you or your environment. If you are on isolation precautions in a hospital, remind providers if they come into your room without the proper gowns (which should be tied in the back, not flopping around) and gloves.

-Prevent many infections in the first place by practicing good hand hygiene yourself, particularly before handling anything you will put in your mouth.Patient With C-Diff Nursing Care Plan Essay Paper

More information for patients can be found here.

There is also good information here.

Recommendations for Health Care Administrators

-Adopt a robust Antibiotic Stewardship program, utilizing resources such as the CDC’s Core Elements..

-Consider supporting educational campaigns, such as Get Smart Week (Nov. 16-22), to improve prescribing and use practices.

The number of health care-associated infections has increased over the years and generated a lot of interest and concern. The attention tends to be focused on methicillin-resistant Staphylococcus aureus (MRSA), but the less publicised Clostridium difficile is a growing problem. It increases length of hospital stay, causes significant morbidity in patients, affects nurses’ workloads, adds to the cost of cleaning, laundry and disposables, and can lead to ward closures. All NHS trusts …Residents of long-term care facilities are at high risk for Clostridium difficile infection due to frequent antibiotic exposure in a population already rendered vulnerable to infection due to advanced age, multiple comorbid conditions and communal living conditions. Moreover, asymptomatic carriage of toxigenic C. difficile and recurrent infections are prevalent in this population. Here, we discuss epidemiology and management of C. difficile infection among residents of long-term care facilities. Also, recognizing that both the population and culture differs significantly from that of hospitals, we also address prevention strategies specific to LTCFs.Patient With C-Diff Nursing Care Plan Essay Paper

C. difficile is a Gram-positive bacillus that forms spores capable of resisting an array of adverse conditions, including exposure to acidic conditions (pH <1), heat (10 minutes at up 80°C), dehydration, and alcohol-based hand sanitizers (7, 8). In its spore form, C. difficile also resists most routine environmental cleaning agents and may last for months on surfaces (9). Both patients and healthcare workers may acquire spores on their hands, unwittingly disseminating spores throughout their environment and leading to unintended ingestion of the spores. Exposure to C. difficile spores may go unnoticed by individuals with a healthy gut microbiome as the bacteria pass through the intestine without finding an ecological niche. The phenomenon, termed colonization resistance, is a form of host-defense that protects most individuals from enteric pathogens like C. difficile (10). For people with a disrupted gut microbiome, which is most commonly due to a systemic antimicrobial, ingested spores germinate and grow to high concentrations in the intestinal tract with toxin production and spore formation. Similar to infections caused by other Clostridial bacteria, the primary means through which C. difficile causes disease is through toxins. The toxins, TcdA and TcdB, translocate across epithelial cell membranes cause depolymerization of the cytoskeleton, which leads to cell death. Both toxins are involved in disease pathogenesis.Patient With C-Diff Nursing Care Plan Essay Paper

In 2003, several reports described a dramatic increase in C. difficile infection rates associated with increase disease fatality, particularly among older adults (11). This change was caused by the emergence of a new C. difficile strain, characterized as toxinotype III, restriction endonuclease group BI, North American pulsed field gel electrophoresis type 1 (NAP1) and ribotype 027 (12, 13). Frequently referred to as epidemic C. difficile, the BI/NAP1/027 strain has three distinct features that may help explain both its rapid spread and resulting increase in disease severity. First, it is resistant to fluoroquinolone antibiotics. In 2002, these became the most commonly prescribed antibiotic in the United States, which coincides with the emergence of the epidemic strain (14). At least in the outpatient setting, fluoroquinolone prescriptions among adults and older adults in the US remained essentially unchanged from 2000 to 2010, raising the possibility of persistent selective pressure that favors the epidemic over the non-epidemic strain as one reason for persistent and widespread dissemination (15, 16). Second, compared to most non-epidemic strains, BI/NAP1/027 strains have an 18-base pair deletion in tcdC, a gene that is a putative negative regulator of toxin production (17). Some studies have demonstrated that the BI/NAP1/027 strain produces greater concentrations of toxins TcdA and TcdB in vitro than other strains (18). However, a recent study found that BI/NAP1/027 strains exhibited robust toxin production, the amounts were not significantly different from those of non-BI/NAP1/027 strains tested (19). Moreover, a recent study involving precise genetic manipulation demonstrated that an aberrant tcdC genotype did not result in increased toxin production (20). Finally, the BI/NAP1/027 strain produces CDT, a binary toxin associated with more severe diarrhea, higher fatality rates and increased risk of recurrent disease (21, 22). CDTb binds the cell surface and induces translocation, thus permitted CDTa access to cytosolic contents and promotes cell death through cytoskeletal depolymerization, acting upon different molecular targets than TcdA and TcdB (23).Patient With C-Diff Nursing Care Plan Essay Paper

Since the advent of the BI/NAP1/027 strain, rates of C. difficile infection steadily increased, such that by 2009, it was part of nearly 1% of all hospital stays (24). These hospital stays disproportionately involved older adults. In 2009, the rate of C. difficileinfection-related hospitals stays for adults 65 – 84 years and ≥ 85 years was 4- and 10-fold greater, respectively, than for adults 45 – 64 years (24). Hospitalized patients developing C. difficile infection are more likely to be discharged to a LTCF (25–27), yet we know relatively little about the burden of this disease among this vulnerable population.

The occurrence and undesirable complications from health care–associated infections (HAIs) have been well recognized in the literature for the last several decades. The occurrence of HAIs continues to escalate at an alarming rate. HAIs originally referred to those infections associated with admission in an acute-care hospital (formerly called a nosocomial infection), but the term now applies to infections acquired in the continuum of settings where persons receive health care (e.g., long-term care, home care, ambulatory care). These unanticipated infections develop during the course of health care treatment and result in significant patient illnesses and deaths (morbidity and mortality); prolong the duration of hospital stays; and necessitate additional diagnostic and therapeutic interventions, which generate added costs to those already incurred by the patient’s underlying disease. HAIs are considered an undesirable outcome, and as some are preventable, they are considered an indicator of the quality of patient care, an adverse event, and a patient safety issue.Patient With C-Diff Nursing Care Plan Essay Paper

Patient safety studies published in 1991 reveal the most frequent types of adverse events affecting hospitalized patients are adverse drug events, nosocomial infections, and surgical complications.¹^,²From these and other studies, the Institute of Medicine reported that adverse events affect approximately 2 million patients each year in the United States, resulting in 90,000 deaths and an estimated $4.5–5.7 billion per year in additional costs for patient care.³ Recent changes in medical management settings have shifted more medical treatment and services to outpatient settings; fewer patients are admitted to hospitals. The disturbing fact is that the average duration of inpatient admissions has decreased while the frequency of HAIs has increased.⁴^,⁵ The true incidence of HAIs is likely to be underestimated as hospital stays may be shorter than the incubation period of the infecting microorganism (a developing infection), and symptoms may not manifest until days after patient discharge. For example, between 12 percent and 84 percent of surgical site infections are detected after patients are discharged from the hospital, and most become evident within 21 days after the surgical operation.⁶^,⁷ Patients receiving followup care or routine care after a hospitalization may seek care in a nonacute care facility. The reporting systems are not as well networked as those in acute care facilities, and reporting mechanisms are not directly linked back to the acute care setting to document the suspected origin of some infections.Patient With C-Diff Nursing Care Plan Essay Paper

Since the early 1980s HAI surveillance has monitored ongoing trends of infection in health care facilities.⁸ With the application of published evidence-based infection control strategies, a decreasing trend in certain intensive care unit (ICU) health care-associated infections has been reported through national infection control surveillance⁹ over the last 10 years, although there has also been an alarming increase of microorganism isolates with antimicrobial resistance. These changing trends can be influenced by factors such as increasing inpatient acuity of illness, inadequate nurse-patient staffing ratios, unavailability of system resources, and other demands that have challenged health care providers to consistently apply evidence-based recommendations to maximize prevention efforts. Despite these demands on health care workers and resources, reducing preventable HAIs remains an imperative mission and is a continuous opportunity to improve and maximize patient safety.Patient With C-Diff Nursing Care Plan Essay Paper

Another factor emerging to motivate health care facilities to maximize HAI prevention efforts is the growing public pressure on State legislators to enact laws requiring hospitals to disclose hospital-specific morbidity and mortality rates. A recent Institute of Medicine report identified HAIs as a patient safety concern and recommended immediate and strong mandatory reporting of other adverse health events, suggesting that public monitoring may hold health care facilities more accountable to improve the quality of medical care and to reduce the incidence of infections.³ Since 2002, four States (Florida, Illinois, Missouri, and Pennsylvania) set legislation mandating health care organizations to publicly disclose HAIs.¹⁰^,¹¹ In 2006, the Association for Professionals in Infection Control and Epidemiology (APIC) reported that 14 States have mandatory public reporting, and 27 States have other related legislation under consideration.¹² Participation in public reporting has not been regulated by the Federal sector at this time. Some hospital reporting is intended for use solely by the State health department for generating confidential reports that are returned to each facility for their internal quality improvement efforts. Other intentions to utilize public reporting may be aimed at comparing rates of HAI and subsequent morbidity and mortality outcomes between different hospitals. This approach is problematic as there is currently a lack of scientifically validated methods for risk adjusting multiple variations (e.g., differences in severity of illnesses in each population being treated) in patients’ intrinsic and extrinsic risks for HAIs.^13–15Moreover, data on whether public reporting systems have an effective role in reducing HAIs are lacking.Patient With C-Diff Nursing Care Plan Essay Paper

To assist with generating meaningful data, process and outcome measures for patient safety practices have been proposed.¹³^,¹⁴^,¹⁶ Monitoring both process and outcome measures and assessing their correlation is a model approach to establish that good processes lead to good health care outcomes. Process measures should reflect common practices, apply to a variety of health care settings, and have appropriate inclusion and exclusion criteria. Examples include insertion practices for central intravenous catheters, appropriate timing of antibiotic prophylaxis in surgical patients, and rates of influenza vaccination for health care workers and patients. Outcome measures should be chosen based on the frequency, severity, and preventability of the outcome events. Examples include intravascular catheter-related blood stream infection rates and surgical-site infections in selected operations. Although these occur at relatively low frequency, the severity is high—these infections are associated with substantial morbidity, mortality, and excess health care costs—and there are evidence-based prevention strategies available. Patient With C-Diff Nursing Care Plan Essay Paper

The Centers for Disease Control and Prevention (CDC) developed baseline definitions for HAIs that were republished in 2004.¹⁹ HAIs were defined as those that develop during hospitalization but are neither present nor incubating upon the patient’s admission to the hospital; generally for those infections that occur more than 48 to 72 hours after admission and within 10 days after hospital discharge. Some hospitals use these definitions exactly as written; other hospitals may use some but not all of the CDC definitions; and other health care facilities may need to modify or develop their own definitions. Whatever definition is used, it should be consistent within the institution and be the same or similar to those developed by CDC or those used by other investigators. Having standard definitions is useful if the health care facility wants to compare surveillance results or performance measures within its various medical/surgical specialties, against those of other health care institutions, or with national published data.Patient With C-Diff Nursing Care Plan Essay Paper

During the delivery of health care, patients can be exposed to a variety of exogenous microorganisms (bacteria, viruses, fungi, and protozoa) from other patients, health care personnel, or visitors. Other reservoirs include the patient’s endogenous flora (e.g., residual bacteria residing on the patient’s skin, mucous membranes, gastrointestinal tract, or respiratory tract) which may be difficult to suppress and inanimate environmental surfaces or objects that have become contaminated (e.g., patient room touch surfaces, equipment, medications). The most common sources of infectious agents causing HAI, described in a scientific review of 1,022 outbreak investigations,²⁰ are (listed in decreasing frequency) the individual patient, medical equipment or devices, the hospital environment, the health care personnel, contaminated drugs, contaminated food, and contaminated patient care equipment.

Host Susceptibility

Patients have varying susceptibility to develop an infection after exposure to a pathogenic organism. Some people have innate protective mechanisms and will never develop symptomatic disease because they can resist increasing microbial growth or have immunity to specific microbial virulence properties. Others exposed to the same microorganism may establish a commensal relationship and retain the organisms as an asymptomatic carrier (colonization) or develop an active disease process.Patient With C-Diff Nursing Care Plan Essay Paper

Intrinsic risk factors predispose patients to HAIs. The higher likelihood of infection is reflected in vulnerable patients who are immunocompromised because of age (neonate, elderly), underlying diseases, severity of illness, immunosuppressive medications, or medical/surgical treatments. Patients with alterations in cellular immune function, cellular phagocytosis, or humoral immune response are at increased risk of infection and the ability to combat infection. A person with a primary immunodeficiency (e.g., anemia or autoimmune disease) is likely to have frequently recurring infections or more severe infections, such as recurrent pneumonia.²¹ Secondary immunodeficiencies (e.g., chemotherapy, corticosteroids, diabetes, leukemia) increase patient susceptibility to infection from common, less virulent pathogenic bacteria, opportunistic fungi, and viruses. Considering the severity of a patient’s illness in combination with multiple risk factors, it is not unexpected that the highest infection rates are in ICU patients. HAI rates in adult and pediatric ICUs are approximately three times higher than elsewhere in hospitals Patient With C-Diff Nursing Care Plan Essay Paper

Extrinsic risk factors include surgical or other invasive procedures, diagnostic or therapeutic interventions (e.g., invasive devices, implanted foreign bodies, organ transplantations, immunosuppressive medications), and personnel exposures. According to one review article, at least 90 percent of infections were associated with invasive devices.²³ Invasive medical devices bypass the normal defense mechanism of the skin or mucous membranes and provide foci where pathogens can flourish, internally shielded from the patient’s immune defenses. In addition to providing a portal of entry for microbial colonization or infection, these devices also facilitate transfer of pathogens from one part of the patient’s body to another, from health care worker to patient, or from patient to health care worker to patient. Infection risk associated with these extrinsic factors can be decreased with the knowledge and application of evidence-based infection control practices. These will be discussed in further detail in Chapter 42, “Targeting Health Care–Associated Infections: Evidence-Based Strategies.”Patient With C-Diff Nursing Care Plan Essay Paper

Prolonged hospitalization, due to a higher acuity of illness, contributes to host susceptibility as there is more opportunity to utilize invasive devices and more time for exposure to exogenous microorganisms. These patients are also more susceptible to rapid microbial colonization as a consequence of the severity of the underlying disease, depending on the function of host defenses and the presence of risk factors (e.g., age, extrinsic devices, extended length of stay). Exposure to these colonizing microorganisms is from such sources as (1) endemic pathogens from an endogenous source, (2) hospital flora in the health care environment, and (3) hands of health care workers. A study related to length of hospitalization examining adverse events in medical care indicated that the likelihood of experiencing an adverse event increased approximately 6 percent for each day of hospital stay. The highest proportion of adverse events (29.3 percent) was not related to surgical procedures but linked instead to the subsequent monitoring and daily care lacking proper antisepsis steps Patient With C-Diff Nursing Care Plan Essay Paper

Among patients and health care personnel, microorganisms are spread to others through four common routes of transmission: contact (direct and indirect), respiratory droplets, airborne spread, and common vehicle. Vectorborne transmissions (from mosquitoes, fleas, and other vermin) are atypical routes in U.S. hospitals and will not be covered in this text.

This is the most important and frequent mode of transmission in the health care setting. Organisms are transferred through direct contact between an infected or colonized patient and a susceptible health care worker or another person. Patient organisms can be transiently transferred to the intact skin of a health care worker (not causing infection) and then transferred to a susceptible patient who develops an infection from that organism—this demonstrates an indirect contact route of transmission from one patient to another. An infected patient touching and contaminating a doorknob, which is subsequently touched by a health care worker and carried to another patient, is another example of indirect contact. Microorganisms that can be spread by contact include those associated with impetigo, abscess, diarrheal diseases, scabies, and antibiotic-resistant organisms (e.g., methicillin-resistant Staphylococcus aureus [MRSA] and vancomycin-resistant enterococci [VRE]).Patient With C-Diff Nursing Care Plan Essay Paper

Respiratory droplets

Droplet-size body fluids containing microorganisms can be generated during coughing, sneezing, talking, suctioning, and bronchoscopy. They are propelled a short distance before settling quickly onto a surface. They can cause infection by being deposited directly onto a susceptible person’s mucosal surface (e.g., conjunctivae, mouth, or nose) or onto nearby environmental surfaces, which can then be touched by a susceptible person who autoinoculates their own mucosal surface. Examples of diseases where microorganisms can be spread by droplet transmission are pharyngitis, meningitis, and pneumonia.Patient With C-Diff Nursing Care Plan Essay Paper

Airborne spread

When small-particle-size microorganisms (e.g., tubercle bacilli, varicella, and rubeola virus) remain suspended in the air for long periods of time, they can spread to other people. The CDC has described an approach to reduce transmission of microorganisms through airborne spread in its Guideline for Isolation Precautions in Hospitals.²⁵ Proper use of personal protective equipment (e.g., gloves, masks, gowns), aseptic technique, hand hygiene, and environmental infection control measures are primary methods to protect the patient from transmission of microorganisms from another patient and from the health care worker. Personal protective equipment also protects the health care worker from exposure to microorganisms in the health care setting.Patient With C-Diff Nursing Care Plan Essay Paper

Common Vehicle

Common vehicle (common source) transmission applies when multiple people are exposed to and become ill from a common inanimate vehicle of contaminated food, water, medications, solutions, devices, or equipment. Bacteria can multiply in a common vehicle but viral replication can not occur. Examples include improperly processed food items that become contaminated with bacteria, waterborne shigellosis, bacteremia resulting from use of intravenous fluids contaminated with a gram-negative organism, contaminated multi-dose medication vials, or contaminated bronchoscopes. Common vehicle transmission is likely associated with a unique outbreak setting and will not be discussed further in this document.Patient With C-Diff Nursing Care Plan Essay Paper

In 1985, the Study of the Efficacy of Nosocomial Infection Control (SENIC) project was published, validating the cost-benefit savings of infection control programs.⁸ Infection control programs were proven to be effective as hospitals with certain practices reduced their infection rates by 32 percent, compared with an increase of 18 percent in hospitals without these components over a 5-year period.⁸^,²⁶ Essential components of effective infection control programs included conducting organized surveillance and control activities, a trained infection control physician, an infection control nurse for every 250 beds, and a process for feedback of infection rates to clinical care staff. These programmatic components have remained consistent over time and are adopted in the infection control standards of the Joint Commission (formerly the Joint Commission on Accreditation of Healthcare Organizations, JCAHO). The evolving responsibility for operating and maintaining a facility-wide effective infection control program lies within many domains. Both hospital administrators and health care workers are tasked to demonstrate effectiveness of infection control programs, assure adequate staff training in infection control, assure that surveillance results are linked to performance measurement improvements, evaluate changing priorities based on ongoing risk assessments, ensure adequate numbers of competent infection control practitioners, and perform program evaluations using quality improvement tools as indicated.Patient With C-Diff Nursing Care Plan Essay Paper

Infection Control Personnel

It has been demonstrated that infection control personnel play an important role in preventing patient and health care worker infections and preventing medical errors. An infection control practitioner²⁷ (ICP) is typically assigned to perform ongoing surveillance of infections for specific wards, calculate infection rates and report these data to essential personnel, perform staff education and training, respond to and implement outbreak control measures, and consult on employee health issues. This specialty practitioner gains expertise through education involving infection surveillance, infection control, and epidemiology from current scientific publications and basic training courses offered by professional organizations or health care institutions.²⁸^,²⁹ The Certification Board of Infection Control offers certification that an ICP has the standard core set of knowledge in infection control Patient With C-Diff Nursing Care Plan Essay Paper

Over time, the workload responsibilities of the ICP have significantly increased to encompass additional administrative functions and regulatory compliance reporting, sometimes covering prevention of infection activities in other facilities that belong to the health care system (e.g., long-term care, home care, and outpatient settings). The expanding scope of ICP responsibilities being performed with limited time and shrinking resources has created an imbalance in meeting all tasks, leading to regular completion of only essential functions and completing less essential functions when time permits. In a 2002 ICP survey examining resource allocations, the activity consuming the greatest amount of mean estimated time was surveillance, followed by education, prevention strategies to control transmission, infection control program communication, and outbreak control. In examining the tasks and the time allocations necessary to complete essential infection control responsibilities, a recent expert review panel recommended new and safer staffing allocations: 1 full-time ICP for every 100 occupied beds. Further staffing levels and recommendations are included for different types of health care facilities by bed size.³³ To maximize successful completion of current reporting requirements and strategies for the prevention of infection and other adverse events associated with the delivery of health care in the entire spectrum of health care settings, infection control personnel and departments must be expanded Patient With C-Diff Nursing Care Plan Essay Paper

There is evidence that the BI/NAP1/027 strain may be a common cause of infections in LTCF populations (28–30). In a study of the epidemiology of C. difficile in multiple hospitals in the Chicago area, Black et al. that 67% of patients with C. difficile infection discharged to LTCFs were infected with BI/NAP1/027 strains (27). Among hospitalized patients with C. difficile infection, Archbald-Pannone et al. reported that LTCF residents were significantly more likely to be infected with BI/NAP1/027 strains than those admitted from home (30). Patients infected with BI/NAP1/027 strains had a higher 6-month mortality and greater inflammation based on fecal lactoferrin testing than those infected with non-epidemic strains (25).

Measuring the burden of C. difficile infection in LTCFs requires a standard set of clinical case definitions and surveillance methods that are applicable to that setting (Table 1). While the clinical case definitions are easily applicable across both inpatient and outpatient settings, the current surveillance definitions may be less relevant for estimating the disease burden among LTCFs. Specifically, Mylotte hypothesized that exposure to systemic antibiotics and to C. difficile spores often occurs in hospitals with symptom onset in nursing homes shortly after hospital discharge (28). Accordingly, he proposed subdividing the definition for healthcare facility (HCF)-onset, HCF-associatedC. difficile infection into LTCF-onset, hospital-associated and LTCF-associated (see Table I for details). Using these definitions, Guerrero et al. reported that among 40 patients at a single Veterans Affairs Medical Center (VA) with HCF-onset, HCF-associated disease, 34 (85%) met the criteria for LTCF-onset, hospital-associated C. difficile infection while 6 (15%) had LTCF-associated disease (29). Taking his sample from 4 community nursing homes, Mylotte et al. reported similar outcomes, with 69% of incident C. difficile infections developing within 30 days of admission (31). Using a larger sample of eight diverse geographic areas, the CDC reported a nearly identical rate, with 67% of people with nursing home-onset C. difficile infections having been discharged from a hospital in the previous 4 weeks (32).Patient With C-Diff Nursing Care Plan Essay Paper

Clostridium difficile is the most common infectious cause of healthcare-associated diarrhea and rivals methicillin-resistant Staphylococcus aureus as the most common bacterial cause of health-care associated infections (1, 2). The Centers for Disease Control and Prevention (CDC) estimates that in the United States, C. difficile infections cause 250,000 illnesses and 14,000 deaths annually (3). Associated medical costs impose a burden in excess of $1 billion dollars each year (3). As with most healthcare associated infections (HAIs), strategies to identify, treat and prevent C. difficile infection require a multi-pronged effort that encompasses both acute and long-term care facilities. Supported by a comprehensive body of high-quality studies and guidelines that focus on C. difficile in hospitals (1, 4–6), there is a growing body of literature addressing the additional challenges faced by long-term care facilities (LTCFs). Here, we discuss prevention and management of C. difficile infection in LTCFs, the majority of which are nursing homes.Patient With C-Diff Nursing Care Plan Essay Paper

Although preventing CDI is a top priority, the best way to do so is unclear. Since the introduction of fast, accurate molecular-based polymerase chain reaction (PCR) testing for CDI, research studies have raised concerns about overdiagnosis. Are rising rates a reflection of PCR capturing asymptomatic C. difficile colonization as well as true disease? Depending on their level of understanding about the implications of the testing method, clinicians may be erroneously diagnosing CDI in patients who are colonized with C. difficile but don’t have signs and symptoms of infection or require treatment. Patient With C-Diff Nursing Care Plan Essay Paper

In an attempt to find some of the hidden puzzle pieces that may help put together a clearer picture of true CDI in healthcare, this article explores what C. difficile infection really is, regulations surrounding CDI reporting, the varied types of CDI testing methods available, and the important role nurses have in thoughtful submission of stool specimens for C. difficiletestingOvergrowth of normal gut flora

C. difficile is part of the community of normal gut flora in humans. Its overgrowth is usually kept at bay by more dominant bacterial anaerobes.3 As discussed in detail below, CDI develops when an abnormal increase of C. difficile in the large intestine causes signs and symptoms of gastrointestinal (GI) infection.

In its infectious state, C. difficile produces toxins and spores that resist heat, acid, many antiseptics, and antibiotics. Spores from C. difficile bacteria are passed in feces and spread to food, environmental surfaces, and objects when people fail to perform effective hand hygiene with soap and water. In healthcare facilities, inadequate environmental cleaning of rooms and shared equipment compounds the risk to patients Patient With C-Diff Nursing Care Plan Essay Paper

CDI causes gut inflammation, secretion of fluid and mucus, and colitis.6 Signs and symptoms can range from mild diarrhea to fulminant colitis. The patient may also have fever, abdominal pain, and leukocytosis. If untreated, CDI can lead to sepsis, toxic megacolon, colectomy, and death. Identifying and treating CDI as early as possible is imperative to prevent these devastating consequences.4 However, a person can be colonized with C. difficile without having CDI.

Infection or colonization?

Colonization occurs when bacteria present in the body, such as on the skin or in the mouth, intestines or airway, accumulate without causing disease.7 In their 2017 Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children update, the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA) reported that among adult inpatients in acute care hospitals, the prevalence of asymptomatic colonization with C. difficile is between 3% and 26%.Patient With C-Diff Nursing Care Plan Essay Paper

Toxins A and B, the main virulence factors produced by the C. difficile bacteria, drive the signs and symptoms of infection in patients. These toxins will be present in the stool of a patient with a CDI. They will most likely not be found in stool of a patient who is colonized but not infected with C. difficile.8 In one study, 21% (293 of 1,416) of hospitalized adults tested for C. difficile were positive on PCR testing, but toxins were identified in only 44.7% of those patients (131 of 293).1

Diagnosis of C. difficile without true infection leads to increased costs, unnecessary isolation precautions, and treatment with unnecessary antibiotics.9 These all have the potential to cause unintended patient harm.Patient With C-Diff Nursing Care Plan Essay Paper

The regulatory piece of the puzzle

In the very worthy quest for improved patient outcomes, acute care hospitals and other healthcare facilities track large amounts of data around patient safety measures. In 2011, the Affordable Care Act/Value-Based Purchasing required that all acute care hospitals report lab-identified (LabID) versus clinically identified CDI through the National Healthcare Safety Network (NHSN) database.10 In 2017, hospital-onset CDI became a performance measure that determines a portion of a hospital’s Medicare reimbursement. These data are also available for public perusal via websites such as Hospital Compare and state-specific Departments of Health and Human Services.11

Patient With C-Diff Nursing Care Plan Essay PaperThe definitions NHSN gives to determine CDI are epidemiologic (not clinical) and are built around only a single positive C. difficile lab test result. Positive lab results are submitted to NHSN and placed into three categories:12

* community onset (CO)-positive C. difficile specimens collected in an outpatient or inpatient location 3 days or less after admission to the facility (days 1, 2, or 3 of admission). This category doesn’t affect Medicare reimbursement or public reporting.

* community-onset healthcare facility-associated (CO-HCFA)-collected in an inpatient location 3 days or less after admission to the facility (specifically, days 1, 2, or 3 of admission) or collected in an outpatient location in which the patient was not previously discharged from an inpatient location within the same facility 28 days or less prior to current date of specimen collection. This category also doesn’t affect Medicare reimbursement or public reporting.Patient With C-Diff Nursing Care Plan Essay Paper

* healthcare facility-onset (HO)-positive C. difficile specimens collected more than 3 days after admission to the facility (on or after day 4 of hospital admission). This is considered an HAI and is the focus of this article. This category does affect Medicare reimbursement and is reflected on public HAI websites.

CDI is the only HAI covered in NHSN reporting and surveillance where, despite public scrutiny, rates are not significantly improving. In some states, rates have actually worsened.13

In light of the narrow regulatory definitions for HO CDI and healthcare’s responsibility to treat with medication only when necessary, we need to get CDI testing right. Understanding how facilities test for CDI might help with this piece of the puzzle.Patient With C-Diff Nursing Care Plan Essay Paper

Which test is best?

Healthcare has struggled with CDI testing for many years. Currently, no best practice in testing for CDI is generally accepted. Multiple factors determine the clinical usefulness of a CDI diagnostic test.

* Sensitivity: the ability of a test to correctly identify individuals who truly have a given disease or condition. In other words, does a positive result really indicate the presence of disease?

* Specificity: the ability of a test to correctly exclude individuals who do not have a given disease or condition. In other words, does a negative result really indicate lack of disease?Patient With C-Diff Nursing Care Plan Essay Paper

* Turnaround time (TAT): how labor intensive is it and how soon are the results available?

* Cost: how expensive is acquiring the equipment for the test and running the test?

* Availability: can the lab perform the test? Not all labs have the equipment or personnel needed to perform certain lab tests.9

As discussed earlier, toxins A and B are the main virulence factors produced by C. difficilebacteria and will be present in the stool of a patient with a CDI. Accordingly, any effective CDI test method must target the presence of these toxins to identify true infection in a patient Patient With C-Diff Nursing Care Plan Essay Paper

The first tests for CDI were developed in the 1970s and 1980s. The cell cytotoxicity neutralization assay and toxigenic culture detected C. difficile toxins on a cell culture medium. While very sensitive, these tests lacked acceptable specificity, had a very long TAT, and were not available to all labs.9

In the early 1990s, the enzyme immunoassay (EIA) for C. difficile toxins A and B was developed. EIAs have a quick TAT and are inexpensive and widely available. However, recent studies have shown that the EIA for toxins A and B has a poor sensitivity (between 45% and 60%) and is not recommended as a stand-alone test for CDI Patient With C-Diff Nursing Care Plan Essay Paper

In 2006, an EIA for glutamate dehydrogenase (GDH), an antigen produced by C. difficile, came to market. Although this test has good sensitivity and TAT, it detects all C. difficile, including nontoxin-producing strains, so isn’t as specific in detecting true CDI.14

Some labs use the EIA and the GDH in a two-step method: first GDH for initial screening; then, if the GDH is positive, EIA to detect the presence of toxin. However, this type of testing can produce conflicting results that can be difficult to interpret and might require further testing to confirm a true CDI.9

In 2009, nucleic acid amplification tests (NAAT), which include PCR tests, became available commercially. NAATs detect one or more genes specific to toxigenic strains; the critical gene is tcdB, which encodes for toxin B. This test is quick, producing results in hours instead of days, highly sensitive (80% to 100%), specific (87% to 99%), and now widely available to all labs.9However, studies started to emerge possibly linking elevated reporting of incidence rates to this testing technology. The NAAT detects the presence of the genes responsible for potential toxin production but does not detect the presence of active toxin in stool specimens-meaning that if it’s used as a stand-alone test for disease, it could be detecting C. difficilecolonization as well as C. difficile infection.9 The authors of one study found numerous false positives with the PCR, and the CDC discovered that CDI incidence increased by 43% to 67% in hospitals that changed from toxin EIAs to PCR testing for CDI Patient With C-Diff Nursing Care Plan Essay Paper

More recently, a fecal gastrointestinal pathogen panel (GIP) PCR has become clinically available. Requiring only one stool sample, the GIP tests for many GI infections, including CDI. The GIP can detect genetic markers of toxins A and B and appears to be highly sensitive and specific. However, the transport medium recommended for collection of stool specimens liquefies the stool sample, making it difficult to determine if the specimen collected was formed or liquid stool. (As discussed below, testing for CDI should be performed on unformed stool specimens.) In a 2014 study, Khare et al. recommended further study to determine whether positive GIP results indicate disease or colonization.16

Clinical guidelines for CDI identification and testing have been published by SHEA, the IDSA, and the American College of Gastroenterology (ACG). Although they differ in the type of test they recommend, they all agree that CDI is a clinical diagnosis that is defined by a set of signs and symptoms (most often diarrhea) and (not “or”) a positive lab test confirmation.17 A study by Dubberke et al. concluded that clinical presentation is important when interpreting CDI testing and that validated criteria are needed to indicate when to test for CDI Patient With C-Diff Nursing Care Plan Essay Paper

Nurses drive appropriate testing

More healthcare facilities are finding that appropriate stool submission for CDI testing is the key needed to correctly identify true CDI in their institutions. Many are turning to nurses to drive this effort.

For obvious reasons, nurses aren’t usually decision-makers in choosing the type of lab test a facility will use for CDI. However, nurses can be a huge driver of what type of stool is submitted for testing. The nurse understands the day-to-day clinical picture of patients better than almost anyone else on the healthcare team and will probably be the first to make the connection between clinical signs and symptoms and potential CDI. As the missing piece of the CDI puzzle, nurses can be the facilitators of a timely and thoughtful approach to submission of stool specimens for C. difficile testing that is based on the patient’s clinical history, current signs and symptoms, and recent medication history.Patient With C-Diff Nursing Care Plan Essay Paper

What does diarrhea tell you?

Many pharmacologic and nonpharmacologic interventions can cause a one-time diarrhea event. According to SHEA and IDSA, acute diarrhea is defined as 3 or more loose or watery stools in 24 hours.8,17 This definition or a similar variation is being used by most researchers, the ACG, and the World Health Organization when collecting data or providing literature and/or guidance around identification and treatment of diarrheal illnesses.Patient With C-Diff Nursing Care Plan Essay Paper

So in practice, is clinically significant diarrhea being tested for CDI? A 2015 study suggests maybe not. This retrospective research showed that 36% to 50% of hospitalized patients tested for C. difficile did not have clinically significant diarrhea defined as 3 or more loose stools/24 hours.

What about stool consistency? One source of clarity is the NHSN guidance around stool collection for CDI lab identification. Those experts tell us that the stool specimen submitted for testing should be “an unformed stool specimen that conforms to the container.” This consistency of stool is more likely to indicate infection or inflammation rather than colonization.10 The Bristol Stool Chart is a tool that can help guide nurses in identifying infectious stool consistency that warrants collection and lab identification. (See Bristol Stool Chart.)Patient With C-Diff Nursing Care Plan Essay Paper
The Bristol Stool Chart visually represents how defecation disorders relate to stool consistency. Nurses use this tool to prompt patients to describe the consistency of their stool with minimal embarrassment by asking them to “point to the one that looks most like your stool.” This provides a consistent stool documentation guideline in the electronic health record to support appropriate submission of stools for CDI testing.

Consider a laxative vacation

Something else to consider is how laxative use may affect patients’ stools. Many studies have shown that constipation is a challenge for the growing population of older adults; some research has shown between 50% and 74% of long-term-care facility residents are on a laxative regimen.19 A laxative’s type and dosage can alter stool consistency. Are clinicians submitting loose or watery stools for CDI testing from patients whose diarrhea was triggered by laxatives? Two recent studies revealed that 20% to 44% of patients tested for CDI were on a laxative regimen, which may have been the true cause of their diarrhea Patient With C-Diff Nursing Care Plan Essay Paper

Many healthcare settings are now evaluating patient medications and stopping laxative administration for 24 to 48 hours to see if the diarrhea resolves before submission of stool for CDI testing. This laxative vacation could potentially decrease misidentifying noninfectious C. difficile colonization as CDI, which could lead to unnecessary treatment.

Take steps to prevent transmission

Optimal hand hygiene and appropriate glove use remain the cornerstone for preventing C. difficile transmission via the hands of healthcare workers. Before contact with a patient with CDI, nurses and other healthcare personnel should perform hand hygiene, then don gloves. Following contact with a patient with CDI, healthcare personnel should remove gloves, then perform hand hygiene. Follow these guidelines to reduce risks.20-22

* Because alcohol does not kill C. difficile spores, use of soap and water for hand hygiene is more effective than alcohol-based hand rubs. However, according to the CDC, some data suggest that even with soap and water the removal of C. difficile spores is more challenging than the removal or inactivation of other common pathogens. In addition, alcohol-based products are more effective than soap and water for inactivating nonspore-forming bacteria.20

Patient With C-Diff Nursing Care Plan Essay Paper

Any theoretical benefit from instituting a soap-and-water hand hygiene protocol must be balanced against the potential for decreased compliance resulting from a more complex hand hygiene routine. Consequently, although performing hand hygiene with either soap and water or an alcohol-based product is acceptable in routine situations, soap and water is preferred during a C. difficile outbreak to prevent spore transmission. In addition, hand hygiene with soap and water is recommended after any nursing care that may involve fecal contamination.20,21

* Patients with known or suspected CDI should be placed on contact precautions in private rooms with dedicated toileting facilities. If private rooms are limited, patients with fecal incontinence should be prioritized. If private rooms are not available, patients can be placed in rooms with other patients with C. difficile infection (cohort). Dedicate or ensure proper cleaning of any shared medical equipment.

* Don gloves and gowns before entering patients’ rooms and remove them before leaving the patient’s environment. Perform hand hygiene after removing gloves Patient With C-Diff Nursing Care Plan Essay Paper

Continue these precautions until diarrhea ceases. Because patients shed the organism for days after diarrhea resolves, some institutions routinely continue isolation for several days beyond symptom resolution or until discharge depending upon the setting and average length of stay.21

Seeing the whole picture

Solving the puzzle of CDI in healthcare is complicated. Among the many challenges are a narrow and nonclinical lab identification, regulatory definition, varied CDI testing methods available, and the subjective assessment of CDI symptoms such as diarrhea. Accurate CDI lab identification increases the chances that patients are treated only for CDI infection, not colonization. It also creates an accurate picture of CDI in healthcare facilities, which will allow those examining and evaluating that data to react with interventions that are useful and meaningful.Patient With C-Diff Nursing Care Plan Essay Paper

Clostridium difficile was discovered and isolated from neonates in 1935. It was initially considered a component of the fecal flora of newborns and not thought to be pathogenic (Keessen, Gaastra, & Lipman, 2010). The history of C. diff and other antibiotic resistant pathogens are closely related with the history of antibiotics. The first antibiotic discovered was penicillin by Alexander Fleming while working with Staphylococcus. With this discovery, a surge of natural and synthetic drugs was discovered to treat bacterial infections. During the 1970s, clindamycin and cephalosporins were highly used as an effective antibiotic against bacterial infection but at the same time disrupted the normal, healthy bowel flora, allowing C. difficile to flourish in its place (Barlett, 2006). Scientists first implicated Staphylococcus aureus early on, but only until 1978 was C. Diff first considered as a human pathogen (Tilloston & Tilloston, 2011). A cohort study conducted in 1974, led by Tedesco, administered clindamycin to 200 patients who underwent an endoscopy. Afterwards patients reported having diarrhea. The study found 41 of the 200, and 20 of the 200 patients had diarrhea and pseudomembranous colitis, respectively. Using a Staphylcoccus aureus detection test, S. aureus could not be found in the stool. The scientist further tested the unknown agent on the hamster model, which definitively, showed that Clostridium difficile as the agent in 1978 (Bartlet, 2007). During the next 25 years, much as been done to know more about C. difficle on clinical features, risk factors, diagnosis, management, and especially biology. Patient With C-Diff Nursing Care Plan Essay Paper

History

Clostridium difficile was discovered and isolated from neonates in 1935. It was initially considered a component of the fecal flora of newborns and not thought to be pathogenic (Keessen, Gaastra, & Lipman, 2010). The history of C. diff and other antibiotic resistant pathogens are closely related with the history of antibiotics. The first antibiotic discovered was penicillin by Alexander Fleming while working with Staphylococcus. With this discovery, a surge of natural and synthetic drugs was discovered to treat bacterial infections. During the 1970s, clindamycin and cephalosporins were highly used as an effective antibiotic against bacterial infection but at the same time disrupted the normal, healthy bowel flora, allowing C. …show more content…
Ingestion of the endospore causes infection. Once it reaches the preferred anaerobic environment of the gut, the endospores germinate and begin releasing toxins A and B (Burns & Minton 2011). The presence of C. difficile does not necessarily mean infection. A patient can be positive for C. difficile but have normal stool, which means there is colonization without infection. Patients who have the C. difficile pathogen without experiencing any symptoms allow it to be passed along undetected which contributes to the ongoing spread to others. Only when toxin A and toxin B are released at suitable levels does C. difficile become pathogenic to humans. Once infected, typical symptoms include watery diarrhea, abdominal pain, colitis, fever, and fecal leukocytes. Moderate to severe Clostridium difficile infection (CDI) consist of profuse diarrhea, abdominal distention, leukocytosis, systemic inflammatory response, pseudomembranous colitis, megacolon and death (Sunenshine & McDonald, 2006). With the combination of a highly resilient endospores, and asymptomatic carriers, this allows C. Patient With C-Diff Nursing Care Plan Essay Paper

Patient With C-Diff Nursing Care Plan Essay Paper