Clostridium Difficile C'diff:

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Clostridium Difficile (C.diff)

• Fast Facts

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What is Clostridium difficile (C. diff)?

• C. diff is a bacteria that lives in the
  intestinal tract of about 5 of healthy adults
• C.diff-associated disease (CDAD) occurs when the
  normal intestinal flora is altered which allows
  the bacteria to grow and produce disease causing
  toxin. CDAD is sometimes called antibiotic
  associated diarrhea

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What are the main clinical symptoms of CDAD?

• Common symptoms include watery diarrhea
  (sometimes with blood or pus), fever, loss of
  appetite, nausea, and abdominal pain.
• Complications can include pseudomembranous
  colitis, toxic megacolon, perforations of the
  colon, sepsis, and sometimes death.

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How is C. diff transmitted?

• C. diff is shed in feces and can contaminate high
  contact surfaces such commodes, thermometers,
  bed-side tables, etc.
• C.diff is often spread to patients on the hands
  of health care workers or other people who touch
  a contaminated surface.

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Who gets CDAD?

• Anyone taking antibiotics very few people who
  are not on antibiotics get CDAD
• Persons with inflammatory bowel diseases
• Persons who have had gastrointestinal surgery
• Persons on chemotherapy

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Diagnosis and Treatment

• Residents with diarrhea should have a stool
  specimen tested for C.diff. Testing is not
  recommended for people with no symptoms (i.e.
  screening or test for cure)
• DO NOT USE ANTI-DIARRHEALS
• Treatment
• Stop antibiotics, if possible (23 of cases
  resolve in 2-3 days)
• If diarrhea continues, try Flagyl or Vancomycin

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Why all the recent attention?

• Reports of CDAD disease have increased, noting
  more severe disease and an associated increase in
  mortality.
• The increased rates and/or severity of disease
  may be caused by changes in antibiotic use,
  changes in infection control practices, or the
  emergence of a new strain of C.
  difficile-associated disease with increased
  virulence and/or antimicrobial resistance.

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How can CDAD be prevented in our facility?

• Use antibiotics judiciously
• Use Contact Precautions for patients with CDAD
• If possible, place these patients in private
  rooms or place in rooms (cohorted) with other
  patients with C. difficile-associated disease.
• Use gloves when entering patients rooms and
  during patient care.
• Use gowns if soiling of clothes is likely.
• Dedicate equipment whenever possible. If not
  possible, disinfect equipment between patients.
• Precautions should be continued until diarrhea
  has ceased.
• Wash hands with SOAP and WATER before and after
  caring for patients.

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How can CDAD be prevented in our facility
(cont.)?

• Implement an environmental cleaning and
  disinfection strategy
• Use an Environmental Protection Agency
  (EPA)-registered hypochlorite-based disinfectant
  for environmental surface disinfection after
  cleaning in accordance with label instructions
  generic sources of hypochlorite (e.g., household
  chlorine bleach) also may be appropriately
  diluted and used. (Note alcohol-based
  disinfectants are not effective against C.
  difficile and should not be used to disinfect
  environmental surfaces.)

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A Word on Reporting

• Facility based reporting January 1, 2006-
  December 31, 2006
• Case Definitions
• Health Care-Associated (Initial) Positive
  laboratory diagnostic test, endoscopy or biopsy
  gt48 hours after admission to a health care
  facility.
• Health Care-Associated (Recurrent) Subsequent
  positive laboratory diagnostic test, endoscopy or
  biopsy in an individual with a previous health
  care-associated positive within the prior 6
  months. A subsequent infection which occurs gt6
  months after an initial infection is also
  classified as an initial infection.

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Reporting (cont.)

• Patient Days Reporting
• Reported monthly
• Total Patient Days Sum of the daily census over
  the entire month
• Ex. 12 on the 1st 12 on the 2nd 13 on the
  31st Total Patient Days for the Month

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Further Recommendations

• Form an Infection Control Committee
• Post signs reminding staff, visitors, and
  residents to wash their hands
• Provide inservices for staff on infectious
  disease and control measures

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Reportable Infectious Diseases in Ohio

• Refer to the list of reportable diseases and the
  Northeast Ohio Communicable Disease Report form
  in your packet.
• Cuyahoga Central Disease Reporting
• phone [phone]
• fax [phone]

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Educational Resources

• ODH will be offering infection control courses
  through APIC (EPI 101 EPI 201)
• Courses will take place in Toledo, Columbus, and
  Cambridge
• Go to www.apic.org for course descriptions
• Dates and times will be sent out later

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Hospital C.diff Rateswww.odh.state.oh.us

• Initial Rate (cases per 10,000)
• Jan - 8
• Feb - 8
• Mar - 7
• Apr - 8
• May 8
• June 7

• Recurrent Rate (cases per 10,000)
• Jan - 2
• Feb - 2
• Mar - 2
• Apr - 2
• May 2
• June - 2

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Add Safe Environment Info
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Thank you for your time and attention.

• www.ccbh.net
• 216.201.2020 (option 2)