Combating Clostridium difficile at Home

 

One Hospital's Success and How It Can Help Caregivers

When a 410-bed hospital in Atlanta, Georgia, faced a high rate of hospital-acquired C difficile infections (HO CDI), it decided to tackle the problem head on. Emory Saint Joseph’s Hospital leadership assembled a diverse team of professionals to develop strategies to combat HO CDI in its facility.

Clostridium difficile is a bacteria spread by the oral-fecal route. Antibiotic use raises the risk, particularly in vulnerable and older patients. It strikes approximately half a million people each year. Though usually considered an infection acquired in hospital settings, the team discovered that many patients already had C diff upon admission, underscoring its risk in the community setting.

After investigating the causes of the hospital’s cases between 2014-2016, the team developed the following infection prevention interventions:

*Better diagnostic stewardship. Nurses were allowed to test any loose, unformed stools within the first three days of admission.

*Enhanced environmental cleaning. A more effective sporicidal disinfectant was incorporated in the daily cleaning routine for ALL rooms, not just isolation rooms.

*More judicious use of antimicrobials for infection. Medications called fluoroquinolones were removed from standalone orders and only given when approved through certain channels. Medicines in this category raise the risk of contracting Clostridium difficile.

*Education of staff. The team incorporated training with enhanced communication to bring the best practices for infection control to the forefront.

*Accountability. Staff meetings were held to increase compliance with the new measures.

One year after incorporating these changes, infection rates had dropped 63%. After three years, infection rates had dropped 77%.

The team found the single most effective infection control intervention was handwashing. Simple, thorough washing with water and soap. Alcohol hand gels are not effective.

How can this help patients and their caregivers at home?

Besides the obvious benefit of clinical infection control for its inpatients, caregivers can learn from and incorporate some of this hospital's interventions at home.

This study clearly showed that C diff is a community problem, as well as an institutional one. As obvious as it might seem, the most important things we can do for our loved ones are often the simple ones.

*Wash our hands often and well. Use soap and warm water. Rinse thoroughly. Keep a roll of paper towels at each sink and use them instead of one household towel to dry. Sure, this costs money, but it’s a small price to stop the spread of disease.

*Keep the home clean. This boosts both our emotional and physical well-being. Not all cleaning products kill C diff but can help with general infection control. If you have C diff infection, do your research to find a home-approved product that kills their spores.

*Discuss the administration of fluoroquinolones with the medical provider and resist their over-prescription if C diff has been a problem. Have a respectful conversation and get the necessary answers to your questions. 

You, as a caregiver, are the most important member of the healthcare team caring for your loved one. You are the first-line of defense against infection. Your efforts to give your loved one quality care are not just necessary. They’re vital. Never feel you are “just” the caregiver. Your concerns, questions, and observations are critical to providing the best care possible for your family.

This article is for general information only and not meant to take the place of regular medical care or a physician's advice.

Study information gleaned from an original article in the American Journal of Infection Control, as presented on Medscape.org.