TABLE 3.

Overview of infection control measures12, 35, 40

I Patient a Antibiotic selection b Risk factors for infection c Multidisciplinary team involved in infection control d Patient care guidelines i Catheters ii Antimicrobial use iii Surgical wound care iv Postoperative care v GI care II Accommodation a General consideration to limit the spread throughout the facilities i Cohorting ii Isolation precautions iii Patients suspected of having C diff should be placed in rooms with the following 1 Signage as to risk, required personal protective equipment (PPE) 2 Available barrier PPE with laundry hamper or dedicated waste disposal for PPE 3 Placement in a single room with dedicated toileting facilities 4 If the number of cases exceeds single room capacity then a Prioritize cohorting b Dedicated commode wherever possible III Contact precautions a Signage with precautions on doors of cohort and isolation patients b PPE readily available with instruction placards c Procedures on specific handling with regard to infected patients should be provided to all employees coming in contact—housekeeping to senior attending d Dedicated equipment and/or barrier covers i Wheelchairs ii Commodes 1 SPECIAL handling precautions to prevent spore spread iii BP cuffs iv Lifts v Thermometers (avoid rectal temperatures) vi Other IV Hand hygiene a Soap and water as well as other hand rubs—time and attention to complete washing i Remove gloves ii Alcohol based if dedicated hand washing sink not available (avoid patient sink) iii Wash hands with soap and water at nonpatient sink V Environmental cleaning a All surfaces in the room and items within reach of patients with suspected C diff or other aggressive HAI should be cleaned twice daily with hospital-grade disinfectant b Special attention to patient-specific items and “high touch” surfaces (phone, bedside rails, call and light activators, door handles, faucets, commodes, etc) c Work from clean to dirty d Change cloths and mop heads frequently e Disposable toilet brushes should be used in ALL patients with C diff/HAI f Discharge/transfer level cleaning must occur when patient is cleared g Educational and auditing materials should be developed for environmental/housekeeping and communicated throughout the chain of care VI Visitors a Should receive instruction especially concerning i Hand hygiene ii PPE iii Safe visitation procedures VII Patient transfer a Transportation services and all downstream services/departments should be alerted to and trained in the care of C diff and HAI patients b Educational and audit materials should be made available c Availability of PPE with instruction on proper usage d Coordination with environmental/housekeeping on proper cleaning of transport equipment VIII Patient discharge a Precautions and educational material should be provided for patients and their family members/caregivers.

For more complete information, refer to Best Practices Document for the Management of Clostridium difficile in all health care settings. PIDAC. Ministry of Health and Long Term Care. Published December 2004, Revised November 2007.