Barb and Ana policy

Barbara Starling
Ana Miranda
Microbiology
Rachel Robson
September 22, 2009
Preventing Clostridium Difficile in the Elderly Community
Background:
Clostridium difficile infection is a serious medical problem infecting 300,000 to 3,000,000 hospitalized elderly patients in the United States each year (1). Clostridium difficile, also known as “C-diff” is a bacterium that is one of the most common causes of infection of nosocomial diarrhea (1). In technical terms, Clostridium difficile is an obligate anaerobic, gram-positive, spore-forming, bacillus (2). Clostridium difficile can cause pseudomembranous colitis, megacolon, and perforation (2). The disease was first recognized in the 1970’s (2).The organism is an epidemic not only in hospitals but also in nursing homes and other facilities for long-term care. Elderly patients in long term care facilities taking antibiotics are at risk of becoming infected with C. difficile (3). The longer a patient takes antibiotics the greater chance the antibiotics could disrupt their normal bacteria of bowel, allowing C. difficile bacteria to become established in the colon (4). A prolonged course of antibiotics or the use of two more antibiotics in combination increases the risk of C. difficile (4). C-diff can be transmitted from person-to-person on contaminated equipment, bed lines, bed rails, and bathroom fixtures (3).Other risk factors for C. difficile are age greater than 65; severe underlying illness, death, and nasal gastric intubation (4). The most common symptoms of C. difficile infection include watery diarrhea, fever, loss of appétit, nausea, belly pain, and tenderness (3). C. difficile is a massive concern in long-term care facilities because patients with C-difficile are taking medication to prevent it, in return making it worse, which is causing the patients to take even more inappropriate prescriptions, causing the C-diff to increase. C-difficile is an atrocious cycle of patients being over medicated causing the symptoms of C-difficile to increase. This medical problem needs to get under control because C-difficile can be severe enough to cause death. The policy outlined here will inform the medical facility on how to prevent C-difficile in the elderly communities.
Policy:
The infection of Clostridium difficile is being spread throughout long-term care facilities in the United States, causing the elderly to be at an even higher risk for terminally ill or even death. Ways to prevent Clostridium difficile at Bickford Cottage, where there are 25- 35 patients are as followed:
1. Everyone who enters or encounters needs to clean their hands with soap and water or an alcohol-based hand rub before and after caring for every patient. This can prevent C-difficile and other germs from being passed from one patient to another on their hands (5).
2. Carefully clean long-term care rooms and medical equipment that have been used for patients with C-difficile.
3. Use contact precautions (washing hands, wearing gloves, etc.) to prevent C-difficile from spreading to other patients (5).
4. Whenever possible, patients with C-difficile will have a single room or share a room only with someone else who also has it
5. Health care providers will put on gloves and wear gowns (isolation procedures) while taking care of patients with C-difficile (5).
6. Visitors should be asked to wear gown and gloves.
7. When leaving the room, long-term care providers and visitors must remove their gown and gloves, and clean their hands thoroughly.
8. Patients must stay in their room as much as possible. They should not go to common areas where other that are not infect maybe present
9. ONLY give patients antibiotics when it is necessary as determined by patients primary physician
10. Check the patients for bowel movements and POTTY! Every hour NO MATTER WHAT
To make sure these policies are being met there will be a checklist with these points that will be in all patients’ rooms, which need to be turned in to the director after every shift. C-difficile is cause by patients taking to much medication, which then makes them have irregular bowel, and when a patients sits in their bowel its causes C-difficile to increase. These policy are important because these will decrease the amount of patients that have or at risk for C-difficile. If these policy are not being followed it could lead to facility being terminated and also cause more patients to get C-difficile or even worse die from C-difficile
Conclusion:
To decrease the amount of antibiotic resistant bacteria in the elderly, the health care providers in long-term care facilities need to make sure that every patients is getting checked to make sure they are not sitting in their bowels. Health care providers need to make sure that everyone encountering a patient who has C-difficile is thoroughly washing their hands and follow the contact precautions listed previously. Health care providers also need to make sure that their patients are not getting unnecessary prescriptions that will increase C-difficile. C. difficile is an epidemic in long-term care facilities that can be controlled if long-term care facilities will be more concerned about their patient’s well being than how fast they can their job completed. Some facilities may say that they do not have enough time to check on every patient every hour. Nursing are always busy but if they cut down on their leisure time to about 5 minutes instead of 10-20 minutes then they will have enough to check on their patients. It only takes about 5 minutes to check on their patients.
Reference page:
1.) Novak, Susan& Hollingsworth. “Comparison of the Premier Toxin A and B Assay and the Toxin A/B II Assay for Diagnosis of Clostridium Difficile infection” Journal : clinical and vaccine immunology Vol 15 No. 3 pg 575 -578. March 08

2.) “Frequently Asked Questions: Information for Healthcare Providers” Released August 2004; Updated 07/22/2005

3.) “Clostridium Difficile” Journal: Centers for disease Control and Prevention,……..

4.) Sunenshine, Rebecca and McDonald, Clifford. “Clostridium Difficile-associated disease: New challenges from an established pathogen.” Cleveland Clinic journal of medicine volume 73. No 2. Feb. 06

5.) Sunrise Retirement community, Sioux City, Iowa: Nurse (Employee) personal interview.2009

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