Clostridium difficile Part One: Clinical Overview

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Welcome and Overview

With use and overprescribing of antibiotics, there are certain bacterial infections that increase, including C. difficile. This session will discuss the etiology, transmission, risk, signs, symptoms, and treatment of C. difficile Infection.

This session is one of a series of six sessions for nursing homes to support implementation of principles and practices of antibiotic stewarship and prevention and management of C. difficile infections.

Objectives

  • Describe the etiology (cause) of C. difficile.
  • Recognize risk factors for C. difficile.
  • Discuss signs, symptoms, and diagnosis.
  • Identify the steps in treating C. difficile.

How can you use this session?

This session focuses on a clinical overview of C. difficile infections. The material is intended to be useful for guiding individual practice and as an educational resource staff involved in the care of nursing home residents. Nursing home leaders can review the content in this session and decide which components would be helpful to staff in their facility. The components can be shared and discussed during staff education sessions, or they can be accessed by staff online at any time.

Depending on which components you choose to review and/or share and discuss with staff, this session may take 30-90 minutes.

Orientation

Here is an outline of what is in this session. You can click on the hyperlinks to go directly to a section or scroll down below the outline to see all section content.

Section

Content

What is C. difficile and why should your nursing home focus on preventing it?

Access fact sheet Prevent and Manage Infections Safely: C. difficile

Watch video CDC Expert Commentary: Dying From C. diff: Who Is Most Vulnerable?

Watch video Clostridium difficile Video

Clinical Overview of C. difficile

Review CDC's FAQs

Watch recorded webinars CDI Management in Post-Acute Care: Part 1 and CDI Management in Post-Acute Care: Part 2

Activity

True/False

Discussion questions

Take Home Messages

Review short narrative

Evaluation

Complete evaluation

Optional Tools and Resources

Access additional tools and resources on C. difficile

What is C. difficile and why should your nursing home focus on preventing it?

Review this leadership fact sheet titled Prevent and Manage Infections Safely: C. difficile (fact sheets for consumers and for staff are also available).

 

 

 

 

Watch this video titled CDC Expert Commentary: Dying From C. diff: Who Is Most Vulnerable?, presented by Nimalie Stone, MD, MS, a medical officer at the Centers for Disease Control and Prevention (CDC) (6:00). NOTE: You will need to set up a free Medscape account to view this.

Dr. Stone talks about a new study published in the New England Journal of Medicine that describes the burden of Clostridium difficile infection (C. diffcile) in the United States. CDC's new study describes data from 2011 on infections among patients in hospitals, nursing homes, and in the community, and indicates that the risks for C. difficile infection and death increase with age in every setting.

Suggested audience:

  • Nurses
  • Administrators
  • Department leaders
  • Pharmacists

Key points:

  • A new CDC new study found that C. difficile caused nearly half a million infections among US patients in a single year. Approximately 29,000 patients died within 30 days of the initial diagnosis. Based on other estimates of the attributable mortality in hospitalized patients, about half this number (15,000 deaths) were probably directly caused by C. difficile infection.
  • Two out of every three healthcare-associated C. difficile infections occur in patients aged 65 years or older. More than 80% of the deaths associated with C. difficile infection occurred among Americans aged 65 years or older, and one out of every nine older adults with a healthcare-associated C. difficile infection died within 30 days of diagnosis, according to the new study.
  • More than 100,000 C. difficile infections develop among residents of US nursing homes each year, making C. difficile infections among the most serious healthcare complications that affect the nursing home population.
  • Patients who take antibiotics are most at risk of developing C. difficile infection. When a person takes broad-spectrum antibiotics, beneficial bacteria that are normally present in the human gut to protect against infection can be suppressed for several weeks to months. During this time, patients can become infected with C. difficile picked up from contaminated surfaces or spread from person to person.

Watch this video titled Clostridium difficile Video, produced by the Canadian Society of Intestinal Research: GI Society (6:24).

The Canadian Gastrointestinal Society provides an overview of C. difficile infection, including symptoms, risk factors, likelihood of recurrence, treatment, spread, and environmental cleaning.

Suggested audience: Anyone; This video may be a good option for all staff, residents, and families as it makes the topic easy to understand.


Clinical Overview of C. difficile

More detailed information is available for clinicians from the CDC. Review answers provided by the CDC for the following questions:


Watch this recorded webinar titled CDI Management in Post-Acute Care: Part 1, presented by Robin L. P. Jump, MD, PhD, Geriatric Research, Education and Clinical Center (GRECC), Louis Stokes Cleveland VA Medical Center, Assistant Professor of Medicine, Division of Infectious Diseases and HIV Medicine, Case Western Reserve University (13:28).

Presentation objectives:

  • Describe the pathophysiology of C. difficile infection.
  • Identify risk factors for C. difficile infection.

For the presentation slides: PDF

For the presentation transcript: PDF

Suggested audience:

  • Nurses
  • Infection control practitioners
  • Administrators
  • Department leaders
  • All staff

Watch this recorded webinar titled CDI Management in Post-Acute Care: Part 2, presented by Robin L. P. Jump, MD, PhD, Geriatric Research, Education and Clinical Center (GRECC), Louis Stokes Cleveland VA Medical Center, Assistant Professor of Medicine, Division of Infectious Diseases and HIV Medicine, Case Western Reserve University (30:10).

Presentation objectives:

  • Explain diagnostic criteria for C. difficile infection.
  • Discuss treatment of C. difficile infection.
  • Describe actions to minimize transmission of C. difficile by staff and residents.
  • Identify actions to minimize environmental reservoirs of C. difficile.

For the presentation slides: PDF

For the presentation transcript: PDF

Suggested audience:

  • Nurses
  • Infection control practitioners
  • Administrators
  • Department leaders
  • All staff

Activity

True/False: Discuss if these statements are true or false, and why.

A principle risk factor for developing C. difficile infection is exposure to antibiotics.

See answer...

Stool samples for C. difficile testing should contain formed stool.

See answer...

Treatment for C. difficile is the same for non-severe and severe cases.

See answer...

C. difficile can be a deadly infection in the elderly.

See answer...

Stool samples for C. difficile should be submitted at the end of the treatment course.

See answer...

Discussion question: A resident’s diarrhea stool sample has just come back as positive for CDI. What actions need to be taken at this time?

Potential responses...


Take Home Messages

  • Antibiotics are the most important risk factor for developing C. difficile infection.
  • Advanced age is the second most important risk factor for developing C. difficile infection.
  • The main clinical symptoms of C. difficile infection include watery diarrhea, fever, loss of appetite, nausea, and abdominal pain/tenderness.
  • In about 20% of patients, C. difficile infection will resolve within 2-3 days of discontinuing the antibiotic to which the patient was previously exposed. The infection can usually be treated with an appropriate course (about 10 days) of antibiotics, including metronidazole, vancomycin (administered orally), or recently approved fidaxomicin.
  • No “tests of cure” meaning, after treatment, repeat C. difficile testing is not recommended if the patients’ symptoms have resolved, as patients may remain colonized.

Evaluation

Complete this evaluation only if you would like to earn nursing contact hours or a certificate of completion.

If you have any questions about or any problems completing this evaluation, please contact continuing-ed@metastar.com or call 608-441-8243 and we will be happy to help you.


Optional Tools and Resources

Clinical Practice Guidelines for Clostridium difficile Infection in Adults: 2010 Update by the Society for Healthcare Epidemiology of America (SHEA) and the Infectious Diseases Society of America (IDSA)
 

Guidelines for Diagnosis, Treatment, and Prevention of Clostridium difficile Infections

 These guidelines were published by the American College of Gastroenterology in 2013.

 

Algorithms for Prevention and Management of Clostridium difficile Infections in Long-term Care Facilities

This resource includes algorithms developed by the Minnesota Department of Health for early recognition and testing, contact precautions, room placement, identifying lower risk roommates, environmental cleaning and disinfection, and social and activity precautions.

 

 

Dawn of the Diff (C. diff Rap Zombie Anthem) Video (2:02)

This is a self-described “silly” rap video from ZDoggMD (Dr. Zubin Damania) on how our overuse of antibiotics, along with a lack of adherence to proper infection control practices, has unleashed this unnatural plague (C. difficile infection) upon the unsuspecting bowels of the world. ZDoggMD is an internet personality that produces music videos about medical issues. He is a practicing MD and features other MDs as characters in his videos.

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