C difficile


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C difficile

  1. 1. A New GuideC DifficileMedical Surgical Nursing II
  2. 2. CDI’s Development• C difficile attaches to receptors in the gutepithelial cell• Pivotal is exposure to antibiotics, whichdestroys the normal gut microbiota and allowsintestinal organisms that are not killed by theantibiotic to proliferate
  3. 3. CDI’s Development• C difficile attaches produces toxins, resultingin pseudomembranous colitis and, in somecases, toxic megacolon and death• Normal intestinal flora are able to suppress Cdifficile and toxin production, preventing thediarrhea and inflammation characteristic
  4. 4. CDI Risk Factors• Main risk factors for CDI:– Exposure to antibiotics– Hospitalization– Advanced age
  5. 5. CDI vs. Antibiotics• Antibiotics:– Most antibiotic classes have been implicated in CDI,but certain antibiotic classes, such as cephalosporins,clindamycin, and fluoroquinolones, are more likely tofacilitate development of disease• antibiotics to disrupt normal lower intestinal microbiota– Fluoroquinolones are hypervirulent strains known asrestriction endonuclease analysis type BI• Virulence is r/t increased production of toxin A; B & Binary• Synergistic with toxins A and B.
  6. 6. CDI Diagnosing• CDI is a toxin-mediated disease, which is thebasis testing– enzyme immunoassay (EIA) for toxins A and B– toxigenic stool culture– cell cytotoxicity– glutamate dehydrogenase testing– polymerase chain reaction (PCR),
  7. 7. TESTING INS & OUTS• EIA– relatively inexpensive,• easy to perform,– rapid turnaround time– poor sensitivity, can result in repeat testing and overtreatment.• Toxigenic stool culture, cell cytotoxicity, and glutamate dehydrogenasetesting– Expensive– slower,– complicated to perform• PCR– used either alone or in combination with EIA• Understand the limitations of the test & how results might changewith a different test.• Testing only symptomatic patients– Pt. who are tested must be having diarrhea
  8. 8. CDI’s Surveillance &Tracking• Surveillance– guide defines surveillanceas regarding a health-related event to reducemorbidity and mortalityand to improve health– use of a case definition forCDI,– identification of thepatient population at risk,– calculation of CDI rates,– use of control charts• Tracking– CMS Inpatient PPSrequired– Reporting of laboratory-identified CDIs throughNational Health SafetyNetwork (NHSN)
  9. 9. Transmission of C difficile• Ingesting spores found in the environmentthat were shed by another patient• Beds• Toilets– flush mechanism– the sink faucet– the door handle• Everyday items
  10. 10. CDI Cross-Contamination• Sharing of electronic thermometers• Oral care or oral suctioning when hands or itemsare contaminated;• Administration of tube feedings or medication;• Emergency procedures, such as intubation;• Sharing of patient care items without appropriatedisinfection;• Use of contaminated mobile, cellular, orconventional telephones or pagers during patientcare
  11. 11. CDI Prevention• Contact isolation• Environmental cleaning• Hand hygiene• ABHR - alcohol-based hand rubs• Best way – Gloving– removed properly to avoid contaminating• During outbreaks hand washing rather thanhand rubs
  12. 12. Thanks…..