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Clostridium difficile

Clostridium difficile. Presented by Nate Smith, MD, MPH Carole Yeung, RN CIC. Outline. Epidemiology Treatment Prevention. What is Clostridium difficile?. Anaerobic spore-forming bacillus Present in the soil and environment Produces two toxins – Toxins A and B

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Clostridium difficile

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  1. Clostridium difficile Presented by Nate Smith, MD, MPH Carole 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 *2005 data incomplete

  6. 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

  7. 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

  8. C. difficile colonization • Patient exhibits no clinical symptoms • Patient tests positive for C. difficile organism and/or its toxin • More common than CDAD

  9. C. difficile disease (CDAD) • Patient exhibits clinical symptoms • Patient tests positive for C. difficile organism and/or its toxin

  10. Laboratory Tests for CDAD • Stool culture • Antigen detection • Toxin testing

  11. 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

  12. Treatment • Discontinue antibiotics if feasible • Metronidazole orally for 10 days • Vancomycin orally • Relapses are common • Repeat testing NOT recommended • NO antiperistalic agents

  13. Infection Control Preventive Methods • Use antibiotics judiciously • Early diagnosis • Contact precautions for patients with CDAD • Hand hygiene • Environmental cleaning and disinfection

  14. Contact Precautions • Private room or cohort • Gloves • Gowns • Dedicated patient care equipment

  15. 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

  16. Cleaning and Disinfection • Clean/disinfect environmental surfaces and reusable items • Hospital disinfectant • 1:10 bleach

  17. Discontinuing Precautions • NO diarrhea. NO precautions! • Repeat testing NOT recommended

  18. Transfer of Patients • Notify receiving facility if patient has a history of C. difficile • Observe for recurrence

  19. References • SHEA Position Paper CDAD, ICHE 1995 • SHEA Position Paper C. difficile in LTCF for the elderly, ICHE 2002

  20. QUESTIONS?

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