Nurse-driven C. diff protocol good for patients

Earlier testing helps patients, hospital
April 13, 2016

memorial hospital, which started a new nurse-driven C. diff protocol.Memorial Hospital has adopted a new nurse-driven protocol to more efficiently identify patients who have Clostridium difficile – C. diff. – and the hospital is using a new disinfectant to kill the spores that the organism produces.

While hospital-associated C. diff infections are on the rise in hospitals across the nation, the number is actually trending downward at Memorial.

Memorial’s infection prevention manager, Phyllis Woods, said that when a patient comes in with diarrhea – a key indicator of C. diff – and there is no other recognized cause, the test should be performed as soon as possible.

Problems can occur when a patient presents with diarrhea with no other recognized cause and the test is ordered greater than four days after admission. The way the CDC defines the criteria if the patient tests positive for C. diff outside the four-day window, the hospital gets tagged with an HO – healthcare onset – even if the patient likely had C.diff upon admission.

“In other words, it looks like the infection came from the hospital when, in fact, the patient may have actually arrived at the hospital with C. diff,’’ Woods said.

Now, a new nurse protocol allows a nurse to test a patient who comes in with diarrhea immediately. The sooner the infection is discovered, the sooner it can be treated, and special precautions initiated to protect other patients and staff.

Research shows a direct correlation between the overuse of antibiotics and C. diff infections. Antibiotic use in the United States is widespread. Although the U.S. accounts for only 4.6 percent of the world’s population, the nation uses 46 percent of the antibiotics prescribed worldwide.

While antibiotics are extremely useful, they should only be prescribed for the right reason.

“The public has to be educated about this,’’ Woods said. “The general public perceives that receiving antibiotics is a normal part of treatment.  Sometimes, it may not be necessary and in some cases, the drug may actually cause problems.’’

Antibiotics, Woods said, disrupt the normal bacterial flora in a person’s intestines. Antibiotics may kill off some of the important flora, causing the bacteria known as C. diff to multiply rapidly. As the C. diff multiplies, it releases toxins that attack the lining of the intestines. A C. diff infection can range from mild to severe and even life-threatening.

Ironically, the treatment for someone who has C. diff is another antibiotic – one that is different from the antibiotic that caused the original C. diff infection.

When infection prevention learns that a patient in the hospital has C. diff, they immediately begin looking for common denominators.

“Is there a room that has been implicated, though we have never found a casual association between the two here,’’ she said.

Infection prevention notifies Environmental Services. In January, Memorial began to use a new sporicidal disinfectant, Perisept.

“We are using it exclusively in C. diff rooms because it has a two-minute kill time for spores. C diff can be a normal inhabitant of the gut, and it is a vegetative bacteria when it is inside the gut, but when it is exposed to air, it becomes a tough little spore,’’ Woods said.

“Environmental Services stops using the regular hospital-grade disinfectant, and they go to Perisept,’’ she said.

Woods said it is important to identify any potential C. diff infections at the earliest opportunity. Infections like these harm patients, increase length of stay and hospital costs.

All of Memorial’s departments have been trained on the new nurse-driven protocol and staff have been educated to use soap and water on those patients who have C. diff because the friction removes the bio-burden from hands, Woods said.

“We’ve just begun these protocols, so the desired outcome might take time before we see results, but this is something that has our full commitment,’’ Woods said.

About the author

Erin Emery is editor of UCHealth Today, a hub for medical news, inspiring patient stories and tips for healthy living. Erin spent years as a reporter for The Denver Post, Colorado Springs Gazette and Colorado Springs Sun. She was part of a team of Denver Post reporters who won the 2000 Pulitzer Prize for breaking news reporting.

Erin joined UCHealth in 2008, and she is awed by the strength of patients and their stories.