| 1. Enhanced contact precautions measures for patients with C. difficile infection (CDI)
|
Hospital Precautions
Rooming – patient placed in private room or with another patient with documented CDI infection Signage – contact precautions posted on door, alcohol dispenser in/or assigned room covering dispense Duration - Contact precautions should be initiated/maintained for entirety of admission or 90 days from the last positive test (whichever is longer). Patients readmitted to the hospital within 90 days should also be placed in contact isolation, and patients awaiting fecal microbiota transplant (FMT) Accessibility – Personal protective equipment (PPE) should stocked and available in necessary sizes; room sink should be easily accessible for washing hands
|
Staff specific precautions
Hand hygiene before gloves – Use alcohol gel or soap and water prior to wearing gloves Wash with soap and water before exiting– wash hands with soap and water after patient encounter Disposable equipment – When possible, disposable equipment (including stethoscopes) should be used; otherwise all equipment must be cleaned with sporicidal agent PPE wearing – Put on gowns and gloves prior to entering room and gown should be tied; PPE may be disposed in room once patient interaction complete and proper hand washing should occur thereafter
|
| 2. C. difficile diagnostic testing
|
| When to test… |
Adults
Patient with diarrhea (≥ 3 unformed stools* in the previous 24 hours), particularly those with risk factors, and no alternative etiology for diarrhea Patients with IBD with flare symptoms Hospital admitted patients within first 48 hours of admission with complaints of or any unexplained loose stools prior to admission Patient treated for CDI with prior resolution of symptoms who may have new infection (i.e., symptomatic, diarrhea)
|
Pediatric
Patients ≥ 12 months with appropriate clinical findings (≥ 3 unformed stools* in the previous 24 hours), particularly those with risk factors and no alternative etiology for diarrhea Hospital admitted patients > 3 years within first 48 hours of admission with complaints of or any unexplained loose stools prior to admission Patient treated for CDI infection with resolution of symptoms who may have new infection *Stool episodes should be measured as ≥ 3 unformed stools from patient’s baseline bowel movements per day |
DO NOT test… (Applicable to adult and pediatric)
Patients < 12 months without appropriate clinical findings Patients on laxatives Any admitted patient age ≥ 3 years with < 3 unexpected liquid/loose stools after 48 hours of admission A patient still taking oral vancomycin for CDI Patients treated for CDI without complete resolution of symptoms with possible relapse If patient had a C diff test result within last 7 days Asymptomatic patients for nursing home placement Patient near end of CDI treatment (i.e., testing for cure)
|
3. Environmental disinfection
Environmental Services perform room cleaning using bleach or peracetic acid (used daily and/or at discharge), and ultraviolet light disinfection (at discharge). Adequacy of room cleaning assessed by direct observations of cleaning practices, microbiologic culturing of rooms before and after cleaning, or use of a fluorescent marker applied to surfaces before cleaning (the marker is checked after cleaning to see if it has been removed, which would indicate adequate cleaning).
|
