C. diff. In Schools – A Guide For School Nurses

What is C. diff (Clostridium difficile) ?

Clostridium difficile is gram-positive, anaerobic, and a spore, rod/spindle-shape,
a common bacterium of the human intestine in 2 – 5%. C diff. becomes a serious gastrointestinal infection when individuals have been exposed to antibiotic therapy, and/or have experienced a long-term hospitalization, and/or have had an extended stay in a long-term care facility. However; the risk of acquiring a C diff. infection (CDI) has increased as it is in the community and found in outpatient settings. There are significant risk factors in patients who are immunosuppressant, ones who have been on antibiotic therapy, and a higher risk  is in the elderly population.

How Can  Antibiotics Cause a  C. diff. Infection?

The antibiotics cause a disruption in the normal intestinal flora which leads to an over growth of C difficile bacteria in the colon. The leading antibiotics known to disrupt the normal intestinal flora, yet not limited to, are Ampicillin, Amoxicillin, Cephalosporins, Clindamycin, and the broad spectrum antibiotics.

Every year since 2012 the CDC shared a public announcement regarding antibiotic use: Colds and many ear and sinus infections are caused by viruses, not bacteria. Taking antibiotics to treat a “virus” can make those drugs less effective when you and your family really need them. Limiting the usage of antibiotics will also help limit new cases of CDI.
*Always discuss the symptoms and medications with the treating Physician.

How is C. diff. spread?

The mode of transmission for C. diff. is through the fecal-oral route and primarily by contaminated hands, and the C. diff. spores are ingested.   This occurs by coming in contact with contaminated equipment, objects, and surfaces contaminated with the spores.
The C. diff. spores will live on inanimate objects for a very long time.

School Nurses:  If two or more cases are reported within one classroom please contact the local health department for assistance.

“Raising C. diff. Awareness” will decrease the panic and lower anxiety with students, staff, and parents.   Please contact the Foundation (1-844-367-2343) for brochures and literature that can be shared to aid in  “Raising C. diff. Awareness.”

Decrease the spread of infection (Infection Control) measures to be taken:

  •    Hand-Hygiene – instructions, demonstrations, information.
  •    Hand Sanitize gels are not effective eliminating and eradicating C. diff. Spores.
  •    Gloves should be worn when coming in contact with wounds, body fluids, including
    stool.
  •    All hard surfaces that have been  contaminated with C. diff. (e.g., commodes, etc..) and **high touch areas need to be disinfected with an EPA-Registered disinfectant labeled with the following information from the U.S. EPA – List K http://www.epa.gov/sites/production/files/2015-09/documents/list_k_clostridium.pdf
**  HIGH TOUCH AREAS TO BE DISINFECTED:
Disinfect “High Touch” surfaces: Door knobs/handles, Door surfaces both sides, Bed rails(in facilities), Call lights, Over-bed tables/drawers, *Phones, Counter-tops of hard non-porous surfaces, Light switches, Furniture, Arms of chairs, Seats of Chairs, Desk Tops, Window sills, Portable bedside commodes, medical equipment being used, diaper pails, toilets, faucets, handrails, sink, tub/shower, locker room benches, shower floors, mirrors, floors of non-porous surfaces, and all hard non-porous surfaces applicable.   (* For mobile phones check w/manufacturer before applying disinfectant to surfaces/screens*)   Wearing gloves during cleaning is suggested, utilizing disposable cleaning clothes/towels is recommended, cleaning cloth should not be reintroduced into a EPA Registered cleaning  solution after wiping down surfaces.
* Noted from U.S. EPA

EPA Label Specifications

http://www.epa.gov/pesticide-registration/guidance-efficacy-evaluation-products-sporicidal-claims-against-clostridium#label

Label Claim

Kills and/or inactivates spores of Clostridium difficile on hard, non-porous surfaces. The product should achieve a mean log reduction of ≥ 6 logs based on recoverable spores.

Special Label Instructions for Cleaning Prior to Disinfection against Clostridium difficile spores

All products bearing Clostridium difficile sporicide claims are to include these specific cleaning directions:

  • Personal Protection: Wear appropriate barrier protection such as gloves, gowns, masks or eye covering.
  • Cleaning Procedure: Fecal matter/waste must be thoroughly cleaned from surfaces/objects before disinfection by application with a clean cloth, mop, and/or sponge saturated with the sporicidal product. Cleaning is to include vigorous wiping and/or scrubbing, until all visible soil is removed. Special attention is needed for high-touch surfaces. Surfaces in patient rooms are to be cleaned in an appropriate manner, such as from right to left or left to right, on horizontal surfaces, and top to bottom, on vertical surfaces, to minimize spreading of the spores. Restrooms are to be cleaned last. Do not reuse soiled cloths.
  • Infectious Materials Disposal: Materials used in the cleaning process that may contain feces/wastes are to be disposed of immediately in accordance with local regulations for infectious materials disposal.
Resource:
Center of Disease Control and Prevention;  http://www.cdc.gov
Cohen SH. Clinical Practice Guidelines for
Clostridium difficile infection in adults: 2010 update by the Society for
Healthcare Epidemiology of America (SHEA) and the Infectious Disease Society of America (IDSA).Infec ControlEpidemiol.2010 May; 31(5):431-55