Thanks to Dr. Fidelma Fitzpatrick (HSE
Clinical Lead for the Prevention of Healthcare-associated Infection) for her guest post on CDI
Clostridium difficile
infection (CDI)
results in a wide spectrum of illness ranging from mild diarrhoea to severe
colitis. CDI is associated with older age, receiving healthcare and antibiotic
use. CDI principally affects hospitalised patients, though recently has become
an important cause of diarrhoea in long term care facilities and in the
community. Patients/residents with CDI experience considerable morbidity and are
more likely to require additional healthcare interventions (e.g., isolation,
additional therapies and procedures). CDI can also cause recurrent infection in
up to 50% patients/residents depending on their underlying risk factors for
infection and the strain of C. difficile causing the
infection.
How can CDI be
prevented?
CDI is prevented by
a combination of clear governance structures: active CDI surveillance, timely
laboratory diagnosis of CDI, antimicrobial stewardship, adherence to appropriate
infection prevention and control measures and timely management of
patients/residents with CDI as outlined in national guidelines.
·
Standard
Precautions should be used at
all times by all healthcare staff when caring for patients/residents.
Standard
Precautions are a group of infection prevention and control practices and
measures that apply to all patients/residents at all times regardless of
suspected, confirmed or presumed infectious status, in any setting in which
healthcare is delivered. When Standard Precautions are consistently
implemented, the risk of transmission of infectious
agents to healthcare workers and patients/residents is minimised.
·
All healthcare
facilities should have an active antimicrobial stewardship programme as
outlined in national guidelines. This should include local antimicrobial
prescribing guidelines to include a restrictive antimicrobial list and efforts
to minimise the frequency, duration and number of antimicrobial agents
prescribed
How is C.
difficile spread and why should I not use alcohol hand rub for hand hygiene
when caring for patients with CDI?
C.
difficile can be transmitted
from patient-to-patient, via contaminated hands, or via environmental (including
healthcare equipment) contamination. C. difficile is also a spore-forming
organism, a property which makes it more resistant to standard disinfectants and
facilitates its persistence in the environment, often for several
months.
·
When caring for
patients/residents with CDI alcohol hand rub should not be used as C.
difficile spores are known to be highly resist ant to killing by
alcohol. The physical
action of rubbing and rinsing is the only way to remove spores from hands (i.e.,
hand washing).
Are additional
precautions required if CDI is confirmed?
Yes.
Contact Precautions
should be used in addition to Standard Precautions for the care of all
patients/residents with CDI in all healthcare facilities as outlined in national
guidelines.
What should I do if
I suspect my patient/resident has CDI?
The following
mnemonic protocol (SIGHT) provides a useful framework when managing suspected
potentially infectious diarrhoea:
S
|
Suspect that a case
may be infective where there is no clear alternative cause for
diarrheoa
|
I
|
Isolate the patient
if in a healthcare facility (e.g., hospital, nursing home). Consult with the
infection prevention and control team where available while determining the
cause of the diarrhoea
|
G
|
Gloves and aprons
must be used for all contacts with the patient and
their environment.
Instruct the patient and carers/family members in hand hygiene and when they
need to use personal protective equipment
|
H
|
Hand washing with
soap and water should be carried out after each contact with the patient and
the patient’s environment
|
T
|
Test the stool for C.
difficile toxin, by sending a specimen immediately. If the patient is
unwell/unstable, contact the consultant microbiologists/ID physician for advice.
|
What
information is available in Ireland on C.
difficile?
The Health
Protection Surveillance Centre (HPSC) has published weekly reports of CDI cases
since May 2008. In addition, quarterly reports are published that contain
additional information on where patients acquired their infection (healthcare
facility or community). CDI is more co mmon in older patients/residents, approx
1.5% have severe infection and in 2012 while the majority of patients present
with symptoms of CDI in healthcare facilities (hospitals or long term care
facilities), 30% of all patients with CDI had onset of their symptoms in the
community.
Further information
on:
·
CDI in Ireland
(including national guidelines, information leaflets, audit tools, weekly CDI
report) http://www.hpsc.ie/hpsc/A-Z/Gastroenteric/Clostridiumdifficile/
·
Hand Hygiene: http://www.hse.ie/eng/services/healthpromotion/handhygiene/
·
Healthcare-associated
Infections: http://www.hse.ie/eng/services/healthpromotion/healthcareassinfection/
·
National
antimicrobial stewardship guidelines; http://www.hpsc.ie/hpsc/A-Z/Microbiol
ogyAntimicrobialResistance/InfectionControlandHAI/Guidelines/File,4116,en.pdf
