C. diff  Prevention Beyond the Basics!

Often just doing the minimum is not enough.

Don't let the spores in the door &
Don't let them spread from the bed!

Clostridium difficile

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Talking Points
C. difficle Prevention: Beyond the Basics

Use These Steps Prevent C. Diff 

1. Be the Last Line of Defense Against the Spores!

  • Rationale: C.diff is spread fecal to oral. The spores shed from an infected person need to get into the mouth of someone else to make them ill.

  • Action: Before taking oral medication and before eating:

    Have ALL PATIENTS wash their hands or use a wipe (made for skin use) to physically remove any C.diff spores from their hands prior to putting oral medication in their mouth or eating any food.

 

  • Suggestions:
     

    1. Single packaged hand wipes can come on patient food trays. Dietary staff can message the need to clean hands prior to eating as a reminder to patients. (Note: Many patients will keep them for after eating to clean hands, so messaging is important!)
       

    2. Nurses can bring in two wipes at the time of each medication administration. One wipe for each hand if patients are not ambulatory and can wash at the sink. 
       

    3. Promoting Hand Hygiene before meals and medication administration will also decrease transmission of other MDROs (MRSA, VRE, CRE).

2. Daily Bathing

  • Rationale: Decrease the bio-burden on the patient and decrease the possible transmission to the environment (and to healthcare workers hands). 

  • Action: Have all patients bath daily whether they are ambulatory or bed ridden. For patients with C.diff Infection (CDI) especially focus on the private areas, torso, and hands. 

  • Suggestions:
     

  1. Many patients don't equate washing with a wipe be bathing. Let them know that they are getting a full bed bath. Use warm wipes specifically for bed baths. Use one wipe for each area.  
     

  2. In the past, using wash basins is has not been recommended since they cannot be cleaned and disinfected between baths. However; there are now one time use basin liners for patients that really want to wash in water. Wash from cleaner areas to dirtier areas. Don't put dirty wash clothes back into clean water.
     

  3. Make sure your clean patient goes back into a clean bed with new clean linen and wearing clean clothes or gown.

3. Bleach Parties 

  • Rationale: C. diff spores can easily ride on the hands, clothes, and equipment. Common areas can harbor and transfer spores to healthcare workers and then potentially to other patients.

  • Action: Bleach all common use areas such as the Nurses station, Medication room, public desk / telephone, and staff break rooms.

  • Suggestions:
     

  1. Create a log and track by shift that the Bleach Parties are actually occurring. Map common areas to highlight places that are more likely to be touched like phones, computer keyboards, Pyxis machines, Omnicell machines.
     

  2. Have staff initial that they were the ones that bleached the common area. It creates accountability and could be used as an incentive with rewards.
     

  3. Have assigned staff to each area per shift and have them initial that the completed the task.
     

  4. Bleach comes in wipes and easy for staff to use. Bleach kills C. diff spores. Bleach will also kill other MDROs. 

Download the sample log to start your Bleach Parties! Make sure to customize your location: [ EXCEL ] [ PDF ]

4. Don't Let C.diff In!

  • Rationale: Keeping C. difficile isolated is the only way to stop transmission. Isolating empirically decreases the risk of transmission in the Emergency Department (ED), diagnostic testing departments, and on the unit once admitted.
     

  • Actions:

 

  1. Individual: Ask everyone who comes to your doors about their stool pattern in the last 72 hours. That will inform the staff of the possibility of someone entering who has CDI. If a patient reports having had multiple loose stools, isolate immediately, get a loose stool sample, and test for C. diff. If a patient reports one loose stool, isolate, and wait for other signs and symptoms of CDI.

    Suggestion: Develop talking points for staff around empiric isolation and testing for C. difficile. Isolate immediately, test quickly, and de-isolate upon negative test (if no other infectious diseases are suspected by the physician). 

     

  2. RN to RN Report: When a patient is transferred from Skilled Nursing facility to the hospital ask about their stool pattern in the last 72 hours.  Also ask if the patient has tested positive positive for C. diff while at their facility. If yes to loose stools or yes to positive C.diff. Isolate on arrival.

    Suggestion: Isolate if you have any doubt and let your Infection Preventionist look at the time frame of positive result. 

     

  3. Emergency Medical Technician (EMT) to RN Report: When patient comes in via ambulance, they may be unconscious or have an altered mental status, but the EMTs have seen the setting where the patient was found. Ask if they were found in loose stool, did they have a loose bowel movement in the ambulance, did they get a report from patient or family of gastro-intestinal (GI) issues recently?

    Suggestion: On all ambulance transfers, make sure the EMTs are doing hand hygiene and putting on fresh gloves before they enter your ED or go up to the Units. Offer a hygiene station at your ambulance bay with bleach wipes for wiping down the gurney after patient use. Also as a courtesy and to help in the overall public health, offer isolation gowns in case they ran out that shift. 

5. Decrease Bio-burden

  • Rationale: Decreasing bio-burden in the environment will help decrease transmission of C.diff spores. For long length of stay patients after treatment and CDI resolving, transfer pt to new room. The new room with minimal bio-burden will decrease the odds for C.diff transmission.

 

  • Action: Long length of stay patient who is was treated for CDI, now having formed stools for 72 hours, should transfer to another private room and continue in Contact isolation until discharge since they will still be shedding C.diff spores.  

  • Action Steps: Patient should be clean prior to transfer. New clothes / gown / booties should be worn for transfer. All personal belongings should be cleaned and disinfected with bleach if possible prior to transferring to new room. No furniture or equipment used in the old room should move to the clean new room (especially the bed). 

  • Suggestion: For long-length-of-stay patients, do a higher level clean every seven days to decrease the bio-burden in the room. Paying particular attention to bed (frame, mattress, hand rails) and of course putting on clean fresh linen when disinfectant is dry. Try to arrange this when patient is out of the room. Patient should be clean prior to transfer. New clothes / gown / booties should be worn for transfer.