Clostridium Difficile Infection Prevention

Implementation of CDI surveillance

  • Surveillance programs are an important measure used to detect and prevent outbreak of C. difficile within healthcare facilities.  Surveillance programs should fit the needs of your facility while incorporating:
    • Patient care rounds to identify patients with signs and symptoms of CDI
    • Standardized processes for laboratory testing, diagnosis and communication

    • Isolation precautions

    Rooming

    • Place patients in a private room
    • Cohort patients if private room is not available
      • Patients with discordant status of infection or colonization with other epidemiologically important organisms (e.g., VRE and MRSA) are not cohorted.
      • If one patient resolves diarrhea, transfer to clean room
      • If multi-patient rooms are necessary, place spatial separation (minimum 3 feet) between beds; may use privacy curtain or place tape on floor for visual queue.
    • Communicate isolation precautions status
    • Dedicate equipment whenever possible

    Personal Protective Equipment

    • Use gloves when entering patients’ rooms and during patient care
    • Use gowns if soiling clothes is likely
    • Change gloves and gowns and perform hand hygiene when moving from one patient to another when patients are cohorted
    • Practice hand hygienefollowing CDC or WHO recommendations
      • Alcohol-based hand rubs are NOT effective against spore-forming organisms such as C. difficile
      • If an institution is experiencing an outbreak of CDI, hand hygiene should be performed with soap and water after caring for patients with CDI
      • Alcohol-based hand rubs can be used for routine hand hygiene when caring for other patients
    • Continue precautions until CDI symptoms have resolved (e.g., patient has <3 stools in a 24 hour periods)

Environmental cleaning and disinfection

  • CDI patient rooms and patient care equipment are appropriately cleaned and disinfected.
  • High touch areas need to be targeted for proper disinfection.  These areas include but are not limited to:
    • Door knobs/handles
    • Door surfaces
    • Bed rails
    • Call button
    • Phone
    • Overbed table and drawer
    • Countertop
    • Light switches
    • Furniture
    • Arms and seat of patient chair
    • Window sills
    • Bedside commode
    • Medical equipment (e.g., IV controls)
  • Use a hospital grade Environmental Protection Agency (EPA)-registered hypochlorite-based disinfectant for environmental surface disinfection after cleaning in accordance with label instructions.
  • Follow the manufacturer’s instructions for disinfection of endoscopes and other devices.
  • Patient care equipment is dedicated to one patient or cleaned/disinfected between patients.
Antimicrobial stewardship
  • Programs should incorporate a process that monitors and evaluates antimicrobial use and provides feedback to medical staff and facility leadership.

For Long Term Care Facilities

  • Infection control practices in long term care and home health settings are similar to those practices taken in traditional health-care settings.

Updated Tuesday, 10-Jan-2012 12:22:33 CST