C'est difficile? Control with zeal! Quiz

Answer: Difficile.

One of several anaerobes that are gram positive and spore forming, Clostridium difficile is found in the gut flora (bowel organisms) as normal flora. It over- grows when normal bowel flora are killed off with...antibiotics. Other Clostridia cause tetanus and botulism.

Answer: Administration, Medical Staff, Directors of Services, Patients and Visitors.

Control of healthcare associated infection begins from the top down in most hospitals. Policies approved by Administration and Medical Staff are most likely to be followed; these are promulgated from general guidelines or recommendations from the government and/or local health care agency or health department.

Answer: frequent, loose or liquid stool.

Definitions of "diarrhea" actually vary: essentially it is a change in the usual pattern of bowel movement, trending toward the loose, frequent and chronically liquid bowel movement (Medline Plus Medical Dictionary). Case definitions of "GI (gastrointestinal) Infection" as healthcare associated infections will be defined in each particular practice setting (CDC Guidelines for control of infections, Definitions of Infections,Horan, T., et al, in the American Journal of Infection Control, Summer 2008).

Some nurses "know" it is "C. diff" because they can smell the actual C. difficile strain, and they are often accurate.

Answer: Colitis, perforation, ileus, dehydration, and shock leading to death.

Nobody should ignore diarrhea that persists over 24 hours. If it is continuous, it is a medical emergency, requiring IV fluid rehydration and treatment in a hospital. Children with enteritis must be seen in the hospital within a few hours of developing liquid stools, as they have a more labile fluid balance and dehydrate quicker than adults. C.difficile enteritis may persist for months after the symptoms disappear.

Although C. difficile does not result in systemic toxicity, enteritis can open the door to the severe immune response syndrome and resultant shock.

Answer: Wash hands with soap. For surfaces, use non-alcohol cleaners (hypochlorite).

The toxin of C. difficile remains on surfaces for a period of time, from hours to months if not cleaned. Spores survive as well and are resistant to heat and many routine cleaners. Surfaces of patient contact, even at home, must be washed to remove surface soil (soap) and then disinfected (hypochlorite solution).

This is made with household bleach, dilution to a strength of 1:10; one part of bleach is mixed with 9 parts of water. Take precautions with bleach, as it is irritating to respiratory tissues. If no diarrhea is present, the use of another disinfectant that is less irritating is permitted.

Answer: unknown.

One L.A. public health physician and a CDC physician stated that there is no known incubation period and no host factor making it easy to determine who is at risk for C. difficile. Another disturbing fact in 2008 is that more "healthy" and younger patients are acquiring C. difficile enteritis and suffering severe disease and death.

A new toxin associated with C. difficile may be this very virulent culprit: it is still being studied.

Answer: Age over 65 years, use of a proton pump inhibitor, severe underlying illness, nasogastric tube intubation.

C.diffiicle enteritis is not always linked to pre-existing bowel diseases, as they may not be treated with antibiotics; this might mask an underlying problem. The advent of instrument-guided surgery using scopes has made it easier to view the colitis associated with C. difficile, but it is not a risk factor for the disease. A core measure in the US, that is, an expected treatment parameter for some illnesses treated in hospitals, is use of proton pump inhibitor therapy to prevent ulcers. Paradoxically, some CDC experts believe this may be a contributing factor to development of C.difficile due to elimination of protective acid balance in the gut.

Answer: a whitish covering of the internal lining of the small and large bowel with inflammatory foci.

The pseudomembranes can be seen on endoscopy (colonoscopy); this must be performed carefully due to a danger of perforation in acute enteritis cases, but is often necessary to rule out acute bleeding lesions.

Answer: a patient who has C.difficile enteritis.

A cohorted patient should be one with the same infection. If bed capacity is the issue (often seen when this infection is a new entity in a hospitalized person), the recommendation is to assign a bed closest to the bathroom. The use of the bathroom is restricted to the person with enteritis, and the other bed of a two-bed ward is used for a patient with a bedpan or commode that can be emptied and cleaned elsewhere.

This becomes very difficult to manage, so it is optimal to have two C.difficile patients cohorted, or place the patient in a private room until effective treatment is concluded and symptoms are decreasing.

Answer: isolate using gown/gloves for contact until diarrhea disappears and 72 hours of treatment is over.

Once a patient goes home, there is no isolation performed there. There is no isolation performed outside of a patient room, unless a patient has diarrhea. Then use of standard precautions will then apply, including a gown/gloves for contact of any stool. Effective treatment is between 48 to 72 hours, and can even be accomplished by stopping the antibiotics and restoring bowel flora.