6.2 Development of C. difficile Infection

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From the course by The University of North Carolina at Chapel Hill

Infection Prevention in Nursing Homes

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The University of North Carolina at Chapel Hill

Infection Prevention in Nursing Homes

119 ratings

Learn about the role of environment in disease transmission and how to implement standard and transmission-based precautions to prevent the spread of antibiotic resistant bacteria and other infections in your facility.

From the lesson

C. difficile Prevention in Nursing Homes

The goal of this module is to describe the epidemiology and control measures for C. difficile. To obtain CE Credit for this module: Take the Quiz and complete the evaluation at the end of the module, you will be directed to your course completion certificate.

6.1 Epidemiology of C. difficile6:39

6.2 Development of C. difficile Infection6:04

6.3 Cross-transmission of C. difficile8:04

6.4 Control and Prevention of C. difficile9:08

Meet the Instructors

Evelyn Cook
Associate Director
North Carolina Statewide Program for Infection Control and Epidemiology (SPICE)

The major factor contributing to acquisition

of C difficil is systemic antibiotic use.

Antibiotic exposure increases the risk of C difficile infection by at least 6

fold within the first 30 days, and 3 fold for 3 months following exposure.

Up to 85% of patients with Clostridium Difficile

infections have antibiotic exposure in the 28 days before infection.

Antibiotic use increases the risk for C Difficile disease for the next 60 days.

Older age has also been recognized as an important risk factor for

C difficile acquisition and development of severe C difficile disease.

This is likely due to a number of age related changes to the composition of

the fecal flora, blunted immune responses, and reduced gastric acidity.

Older adults also often have more than one condition at the same time,

which can impact the ability to fight off infections.

Recurrent hospitalizations and increased length of stay in health care

also increases the risk for acquiring C difficile.

The microbial flora of the intestines is incredibly diverse, with 200 to

1000 different species of microorganisms comprising about 100 trillion bacteria.

When this ecosystem is intact, it helps us digest food, produce vitamins,

and keep our immune systems in balance.

It also provides protection to the intestines from invading microorganisms.

This is called colonization resistance.

Antibiotic therapy plays a central role in the pathogenesis of C Difficile infection.

Particularly clindamycin, third-generation cephalosporins,

penicillins, and fluoroquinolones.

When antibiotics are consumed, the diversity and numbers of microorganism in

the gut is drastically altered and reduces colonization resistance.

Making colonization and disease with C-difficile more likely.

If C difficile is ingested while the gut flora is suppressed,

it can colonize the gut and start producing toxins.

If the immune response to the toxins is high, diarrhea will not develop.

Conversely, if the immune response to the toxins is low,

residents can go on to develop disease.

C difficile resolves when it is treated with antibiotics allowing the immune

system to respond, and normal gut flora to re-establish itself.

Illness associated with C difficile infection can range from mild diarrhea

to potentially fatal pseudomembranous colitis, toxic megacolon, and death.

The typical signs and symptoms of the disease are watery diarrhea with crampy

lower abdominal pain, often accompanied by fever, nausea, and anorexia.

These symptoms generally last for up to 20 days,

depending on the severity of the illness.

Symptoms of Pseudo-membranous colitis are generally more severe

with diffuse abdominal pain, distension, and

the absence of diarrhea, which is due to a paralyzed bowel or toxic megacolon.

Toxic megacolon is an enlarged colon

that can perforate leading to peritonitis and death.

Common complications associated with C difficile associated diarrhea

are dehydration, low blood potassium levels, intestinal hemorrhage,

toxic megacolon, and bowel perforation in up to 10% of infected individuals.

The last two are true life-threatening emergencies that require

hospitalization for immediate intervention.

>> Priscilla I haven't seen anything like this.

First, MRSA, then the flu, and now C difficile.

I don't get it.

You and the other nurses are washing your hands, right?

>> As best I can tell, everyone is using proper hand touching like they should.

I don't thing the three P's are being followed.

>> The triple threat, Product, Practice, Perfection.

Oh, I could talk about cleaning all day.

I was going to go into environmental services if nursing didn't work out.

>> Earth to Vanessa.

>> Oh.

This C diff outbreak really concerns me.

We need to get everyone cleaning properly, and fast.

I just learned that Miss Turner is infected too.

>> Let's cut right there.

>> Priscilla, let me show you this diagram to help explain why she's concerned.

It shows how C Diff is spread in healthcare facilities.

You can see here that the two main roots of infection are by

contaminated healthcare workers hands, or by contaminated environment.

>> So if the environmental services staff isn't cleaning well and

using bleach to disinfect the rooms of residents with C Diff,

then that could lead to other residents getting colonized or infected.

>> Yes, exactly.

Environmental cleaning disinfection is critical

to fighting the transmission of infection.

And, action.

>> We need to spearhead this disinfection process.

Let's make sure this bath is cleaning well and using a 1:10 bleach solution

to clean shared equipment and rooms occupied by residents with C Diff.

>> Sounds good.

I'll make sure that the nursing staff uses good hand hygiene

when providing care to the affected residents.

>> Be sure to specify that they must use soap and

water, not alcohol based rub because only hand hygiene with soap and

water will effectively remove the C Diff spores.

>> Action.

>> I'll make sure that the nurse and

staff properly wash their hands using soap and water.

>> Yes, we all have to work together to get this fixed, and fast.

[MUSIC]

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