How to Prevent C difficile Infection: A New Guide

Laura A. Stokowski, RN, MS

Disclosures

May 24, 2013

In This Article

CDI Prevention During Patient Care

High-risk activities. According to APIC,[2] patient care activities that pose a higher risk for transmitting C difficile include:

Sharing of electronic thermometers that have been used for obtaining rectal or oral temperatures (handles may be contaminated with C difficile even though probes are changed and probe covers are used);

Oral care or oral suctioning when hands or items are contaminated;

Administration of tube feedings or medication;

Emergency procedures, such as intubation;

Sharing of patient care items without appropriate disinfection; and

Use (even brief) of contaminated mobile, cellular, or conventional telephones or pagers during patient care.

Hand hygiene. It is believed that most transmission of C difficile takes place via the hands of healthcare personnel. The issue of what is best for hand hygiene when caring for patients with CDI often presents uncertainty. Alcohol does not effectively kill C difficile spores, but the use of alcohol-based hand rubs has not been shown to result in an increase in CDI rates.[9] Handwashing with soap and water is more effective, probably because friction, dilution, and rinsing remove more spores from the hands.

During non-outbreak situations, healthcare personnel can use either alcohol-based hand rubs or soap-and-water handwashing for hand hygiene. During outbreaks (increased rates of CDI), staff should use handwashing rather than hand rubs when caring for patients with CDI. The best way to prevent hand contamination is with gloves, but they must be removed properly to avoid contaminating the hands with spores during glove removal.[2]

Compliance with hand hygiene is another factor that cannot be ignored. Healthcare personnel are most likely to neglect hand hygiene during "brief encounters" (entering the patient's room and staying for less than 2 minutes). These brief encounters can involve a lot of patient contact and contamination, but staff might mistakenly view them as low risk. Facilities should focus on brief encounters when educating staff about hand hygiene.

Contact isolation. Prompt isolation of patients in whom CDI is suspected or diagnosed is a key step in prevention; however, APIC does not recommend isolating asymptomatic carriers. Private rooms with bathrooms are ideal, but APIC acknowledges the difficulty that isolation can pose for some healthcare settings. Cohorting is an option when room space is limited, but patients should be moved to clean rooms after their diarrhea resolves.

The Pace of Progress Survey[1] found widely varying contact isolation practices among healthcare facilities, particularly with respect to when contact isolation was discontinued. Some facilities reported continuing isolation until the patient was discharged or tested negative for C difficile, neither of which is recommended. The APIC guide recommends discontinuation of contact precautions when the patient's diarrhea resolves, and consideration of increasing the duration of isolation precautions in epidemic situations or when ongoing transmission is suspected.[2]

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