PIAC Case Series
Case 05 - Clora, 10 Years Old
Cora is a 10 y/o who resides in a long term care facility. She was hospitalized with pneumonia and ileus 3 weeks ago and has made a slow recovery. You have just completed the transfer orders when you are called with fever.
She has received no antibiotics for the past 9 days and there is no indwelling line or foley. She has had 3 loose stools; Stool for C diff is ordered.
Is a + C diff test sufficient to confirm a diagnosis of C. difficile disease?
What are the risk factors for C diff disease?
C. difficile is a spore-forming bacillus that causes colitis, manifesting as diarrhea that often recurs and can progress to toxic megacolon, sepsis and death. C. diff can colonize the bowel (up to 50% of healthy neonates, 5 - 10% adults) but the detection of TOXIN is sufficient for diagnosis in setting of clinical signs/symptoms
PCR test used here detects the gene segment that encodes for toxin; highly sensitive and specific
Risk factors for C diff disease are:
-antimicrobial use (increased risk persists for 3 months after antibiotics are discontinued)
- medical care (94% of cases are associated with various health-care settings)
2) What measures can be taken to prevent spread of C diff?
- When can contact precautions be discontinued?
- What can YOU do to prevent C diff?
Measures to prevent spread of C. diff:
- ANTIMICROBIAL STEWARDSHIP!! Even a single peri-operative antibiotic dose is a risk factor.
- Contact precautions for patients with proven or suspected C. diff; Wear gloves and gowns when examining patients with C diff. Although hand sanitizer does not kill C. diff spores, its use is NOT associated with increased risk. GLOVE USE is key. Clean hands both before and after donning gloves – and can use either soap and water or hand sanitizer.
- Thorough cleaning of room and high touch surfaces is essential. A sporicidal product is used for terminal cleaning.
Contact precautions are discontinued for C. diff :
NO TEST OF CURE IS DONE
- Once patient is on effective therapy and diarrhea has resolved
- Not valid as c diff can persist as colonizer for some time after disease resolves
- Risk of transmission is related to diarrhea and associated spore contamination of patient and environment
What YOU can do to prevent C diff
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- USE ANTIBIOTICS OPTIMALLY!
- Avoid use if no infection
Identify the pathogen and use narrow spectrum when possible