The document discusses Clostridium Difficile (C. Diff), a gram-positive, spore-forming bacteria that causes symptoms like diarrhea, fever, and abdominal pain. Risk factors for C. Diff infection include older age, antibiotic use, and recent healthcare exposure. Current practices to prevent and manage C. Diff involve hand hygiene, contact precautions, environmental cleaning, and discontinuing unnecessary medications after diagnosis. An audit found that in some cases, C. Diff symptoms were masked by primary diagnoses or developed later, preventing early recognition. Recommendations include using a stool scale to document symptoms accurately and maintaining intake/output records to help with early detection and management of C. Diff.

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