Clostridium Difficile Presentation

1. Clostridium Difficile: Prevention,
symptoms, current practice, and
recommendations
Shane Karna, SN
St. Cloud State University

2. Clostridium Difficile
• Anaerobic gram positive spore forming bacteria
• Signs and Symptoms include:
• 3-15 liquid stools per 24 hr., fever, loss of appetite, fever, nausea, and abdominal
pain/tenderness.
• Transmission
• Fecal-Oral Route including tube feedings
• Factors that increase C. Diff. infection risk
• Patients over the age of 65
• Antibiotics, especially fluoroquinolones, cephalosporins, and clindamycin
• Proton pump inhibitors, H2 blockers
• Patient antibiotic exposure within the last 3 months
• Patient Healthcare setting exposure within the last 3 months

3. Current Practice
• Hand Hygiene
• Contact Precautions (PPE)
• Room with private bathroom
• Using dedicated equipment or cleaning equipment immediately after use
• Obtaining only fresh liquid stool for sampling
• Educating the patient, family, and care providers on C. Diff.
• Monitoring Electrolytes and serum creatinine
• Discontinuing non-essential medications after a positive diagnosis
(antibiotics, PPIs, and H2 blockers
• Keeping the environment clean

4. Audit Findings
• Chart audits were performed on four patients who were diagnosed
with C. Diff. four days after their admission
• Nurses followed recommended testing guidelines (3 liquid stools per 24 hr)
• Other C. Diff. symptoms (abdominal pain/tenderness, loss of appetite, fever,
and nausea) were masked by their primary diagnosis or weren’t present until
the fourth day
• One patient was unnecessarily re-tested
• Early C. Diff. recognition wasn’t possible

5. Recommendations
• Bristol Stool Scale
• Accurate documentation of
frequency and stool characteristics
in EPIC notes.
• Maintain accurate intake and
output
• Do not re-test patients who have
been previously treated for C. Diff.
unless the previous treatment
resulted in a clinical cure
• Disinfecting commonly used
surfaces with bleach

6. References
• "Health Professional Information on Clostridium Difficile." Minnesota Department of Health.
2015. Retrieved from http://www.health.state.mn.us/divs/idepc/diseases/cdiff/hcp/index.html
• Bor, B. Clostridium Difficile [Powerpoint]
• "Bristol Stool Chart." Continence Foundation of Australia. 2016. Retrieved from
http://www.continence.org.au/pages/bristol-stool-chart.html
• “Clostridium Difficile Infection (CDI) Prevention Strategies 2.0.” Collaborative Healthcare-
Associated Infection Network. Retrieved from
http://www.mnreducinghais.org/documents/HAIGapAnalysisCDI.PDF