Clostridium difficile Presented by Nate Smith, MD, MPH Carole Yeung, RN CIC.
-
Upload
brandy-layson -
Category
Documents
-
view
214 -
download
0
Transcript of Clostridium difficile Presented by Nate Smith, MD, MPH Carole Yeung, RN CIC.
Clostridium difficile
Presented byNate Smith, MD, MPHCarole Yeung, RN CIC
2
Outline
• Epidemiology
• Treatment
• Prevention
3
What is Clostridium difficile?
• Anaerobic spore-forming bacillus• Present in the soil and environment• Produces two toxins – Toxins A and B• Common cause of antibiotic associated diarrhea
(AAD). 15 – 25 % all episodes of AAD• Health care settings are major reservoirs• 20 – 40% hospital patients colonized• 4 – 20% LTCF residents colonized
4
What are C. difficile-associated diseases (CDAD)
• Pseudomembranous colitis (PMC)
• Toxic megacolon
• Perforations of the colon
• Sepsis
• Death (rarely) but increasing!
5
CDAD-related deaths - Arkansas
0
10
20
30
40
50
60
DE
AT
HS
1999 2000 2001 2002 2003 2004 2005*
*2005 data incomplete
6
7
Symptoms of CDAD
• Watery diarrhea• Fever• Loss of appetite• Abdominal pain• Nausea and vomiting• Severe cases: increase WBC and/or creatinine • Can occur up to 8 weeks after antimicrobial
therapy
8
Which patients are at increased risk for CDAD?
• Antibiotic exposure – clindamycin, penicillins, cephalosporins, floroquinolones
• Gastrointestinal surgery
• Length of stay in healthcare settings
• A serious underlying illness
• Immunocompromising conditions
• Advanced age
9
C. difficile colonization
• Patient exhibits no clinical symptoms
• Patient tests positive for C. difficile organism and/or its toxin
• More common than CDAD
10
C. difficile disease (CDAD)
• Patient exhibits clinical symptoms
• Patient tests positive for C. difficile organism and/or its toxin
11
Laboratory Tests for CDAD
• Stool culture
• Antigen detection
• Toxin testing
12
C. difficile Transmission
• C. difficile spores are shed in feces
• Any surface, device or material that becomes contaminated with feces may serve as a reservoir
• Transferred by hands of healthcare personnel
13
Treatment
• Discontinue antibiotics if feasible
• Metronidazole orally for 10 days
• Vancomycin orally
• Relapses are common
• Repeat testing NOT recommended
• NO antiperistalic agents
14
Infection Control Preventive Methods
• Use antibiotics judiciously
• Early diagnosis
• Contact precautions for patients with CDAD
• Hand hygiene
• Environmental cleaning and disinfection
15
Contact Precautions
• Private room or cohort
• Gloves
• Gowns
• Dedicated patient care equipment
16
Hand Hygiene
Soap and water for at least 15 seconds:
• Wet hands under running water
• Apply soap
• Good friction rub for 15 seconds
• Rinse hands
• Dry well with paper towel
17
18
19
20
21
22
23
24
25
26
27
28
29
30
Cleaning and Disinfection
• Clean/disinfect environmental surfaces and reusable items
• Hospital disinfectant
• 1:10 bleach
31
Discontinuing Precautions
• NO diarrhea. NO precautions!
• Repeat testing NOT recommended
32
Transfer of Patients
• Notify receiving facility if patient has a history of C. difficile
• Observe for recurrence
33
References
• SHEA Position Paper CDAD, ICHE 1995
• SHEA Position Paper C. difficile in LTCF for the elderly, ICHE 2002
34
QUESTIONS?