Preventing a C. diff. infection (CDI) is a multidisciplinary effort in every setting.
It requires everyone, from physicians to nurses, pharmacy to the microbiology laboratory, housekeeping to hospital leadership, family members, patients, visitors, and especially infection prevention and control staff, to do their part.
Let us not dismiss the importance of hand hygiene (hand-washing) or environmental disinfection in all settings…..from healthcare facilities to outpatient clinics to physician offices to the home.
Soap and water should always be used preferentially over alcohol-based hand rubs if the hands become grossly contaminated or if gloves were not worn.
Enhanced cleaning of the environment with sporicidal methods is clearly indicated if your facility has issues with CDI cases occurring repeatedly in the same room. Before changing the approach to cleaning the environment, it is important to make sure that the environment is being cleaned in the first place—the sporicidal agent will not have the opportunity to work if it is never applied.
Existing data indicate that the most effective methods to prevent CDI in hospitals are:
Improving antimicrobial (antibiotic) prescribing; Promptly identifying patients with CDI and place them on contact precautions, and Making sure that healthcare workers are compliant with contact precautions, including gowns, gloves, use of dedicated equipment whenever possible, and ensuring that non-dedicated equipment is adequately cleaned between patients.
Bradley Whitchurch, Founder and Chairman of the Board at Seal Shield, LLC, Dr. Rosie D. Lyles, MD, Clinical Affairs Head, Research and Department, Clorox Healthcare and Shelby Lassiter, BSN, RN, CPHO, CIC, Infection Preventionist at a University Hospital in North Carolina,.
Listen in as these three professionals come together to discuss C. diff. infections,
healthcare-associated infections, and you will want to learn why hand hygiene alone is not enough. Plus discussions about infection prevention measures being utilized in healthcare and home settings to keep everyone safe.
Brad is the Founder, CEO and Chairman of the Board at Seal Shield LLC. Seal Shield is an infection control solutions manufacturer headquartered in Jacksonville, FL. The Company produces waterproof, antimicrobial input devices for healthcare and other global markets. Seal Shield’s primary products include washable, antimicrobial keyboards, mice and TV remote controls. Mr. Whitchurch has been a pioneer in the computer products industry for 25 years.
Dr Rosie Lyles MD
Dr. Lyles is Currently the Clinical Affairs Head, Research and Department, Clorox Healthcare and serves as the primary liaison for Client’s Healthcare division as a department head to relevant professional, research and academic institutions, public health agencies, and forums. The role will provide strategic guidance and assist with the development and implementation of a plan for clinical/scientific support of marketing initiatives. This includes overall responsibility for public health message development, publication planning, key opinion leader development and provides relevant input into the clinical and product intervention design and development.
Shelby Lassiter, BSN,RN,CPHQ,CIC
Shelby holds an Associate Degree in Nursing from Wake Technical College and a Bachelor’s Degree in Nursing from East Carolina University. She is certified in Infection Control (CIC) and is a Certified Professional in Healthcare Quality (CPHQ) through the National Association of Healthcare Quality (NAHQ). She has over thirty-five years of experience in healthcare: medical/surgical nursing, critical care, healthcare quality and infection prevention. Shelby has held a variety of positions in Infection Prevention and is currently an Infection Preventionist at a University Hospital located in North Carolina.
Must include patient name, MRN, date/time of collection and collector’s initials.
ACCEPTABLE SPECIMEN: Feces
Collect specimen as follows: 1. Collect feces in a clean, dry container or bedpan not contaminated with urine, residual soap, or disinfectants. 2. Transfer appropriate volume of feces to a clean dry tightly capped specimen cup. 3. Submit double-bagged specimen cup immediately to laboratory.
NOTES: 1. Patients should be passing at least 3 unformed or watery stool specimens in a 24-hour period. Most patients have more than 3 episodes of watery, foul-smelling stools per day. 2. Soft specimen is defined as specimen assuming the shape of its container (unformed). 3. Formed or hard fecal specimens will not be tested. 4. Repeat testing following a negative test during the same episode of diarrhea is NOT recommended for at least 7-days because of high sensitivity (between 98-99% and with a 99% negative predictive value).
REFRIGERATE IF TRANSPORT IS DELAYED. Specimens can be stored at 2-8 degrees C for 24 hours before significant degredation of the toxin is noted. SUBMIT WITH COLD PACKS OR ON ICE IF TRANSPORT WILL TAKE > 1 HOUR.
DELIVER IMMEDIATELY TO MICROBIOLOGY IN A TIGHTLY SEALED CONTAINER WITH NO EXTERNAL SPILLAGE.
REFRIGERATE IF TRANSPORT IS DELAYED. SUBMIT WITH COLD PACKS OR ON ICE IF TRANSPORT WILL TAKE >1 HOUR.
Causes for Rejection
1. Specimen not labeled with patient’s name, MRN #, date/time of collection, collector’s initials. 2. Container leaking. 3. Specimen received > 2 hours after collection unless submitted on ice or cold pack or with note that specimen stored in refrigerator prior to transport. 4. Formed or hard specimen. 5. Specimen in Cary-Blair transport, Para-Pak (formalin/PVA) or in diaper. 6. Specimen on swab. 7. Patient has negative test within last 7 days. 8. Patient has positive test within last 14 days.
While combating C. diff at home, it is recommended that soiled linens be handled as little as possible to prevent microbial contamination of persons handling the linen. Heavily soiled linens should be laundered separately and not with other clothing or other linens. Satisfactory Laundering has been achieved in “hot” water temperatures cycles in home washers while utilizing chlorine bleach (amount varies with manufacturer and water capacity in each washer) and laundry soap.
Hand-washing with soap and warm water over 20 seconds, scrubbing between fingers, and tops of hands, rinsing with fingers pointed downward, using a dry, clean towel to dry both hands and a dry towel to turn off the sink faucets. This hand-washing process demonstrates the greatest efficiency in removing Clostridium difficile (C Diff) spores and should be performed preferentially over the use of alcohol-based hand rubs when contact with C Diff is suspected or likely. The recommended length of time to wash hands is a minimum of 20 to 30 seconds. Singing one rendition of Happy Birthday usually suffices the time suggested to achieve good hand-washing results.
* 70% isopropyl showed NO inactivation of C. difficile spores at exposure times of 5m, 15m, and 30m.
Cleaning a Home Environment:
What needs to be cleaned at home using EPA approved germicide for routine cleaning? All hard surfaces, which include the bedside commode (if applicable), bed-rails (if applicable), All Bathroom sinks, floors, tub/showers, toilets, doorknobs, light switch plates, shower doors. Frequently touched or high-touch surfaces including computer touch-pads, monitor cables, monitors, Kitchen appliances (i.e., Refrigerator handles, oven handles) sinks, counter-tops, floors and any/all medical equipment being utilized (i.e., walker, wheelchair, IV poles/pumps).
Clean all items that are shared between individuals (i.e., glucose meters, thermometers, b/p cuffs, stethoscopes). *It is best to use disposal wipes, paper towels, or cleaning clothes that can be washed in hot bleach water after cleaning, sponges are not recommended. The dirty cloth should not return to a clean bucket of solution and buckets/containers should be washed and disinfected after each use.
Home Restrooms: To also help prevent spreading C. diff. spores and to prevent reinfection: Restrooms – remove fabric shower curtains – replace with a plain plastic/vinyl shower liner one that will be able to be cleaned with a bleach product. Remove towels hanging on hooks, or stacked near the commode. Store toothbrushes, personal grooming items, and towels in a cabinet, linen closet, in zip-lock plastic bags, or under the vanity sink is a safer location. Remove bath mat/rug or launder daily in hot water with bleach added (color fabrics may fade due to bleach – read manufacturer labels). Cleaning with disposable towels is beneficial. CDC Recommendation is Utilizing Bleach/Water 1:10 ratio: 1 cup of Bleach + 9 cups of water made fresh daily and keeping surfaces wet with solution for ten minutes. Or there is the option to purchase EPA Registered product such as Clorox (TM) Germicidal Solution or wipes to clean hard non-porous surfaces and leaving surfaces wet for up to five minutes to kill C. diff. spores. Environmental safety is a sure way to prevent spreading the C. diff. spores and/or reinfecting the patient
While visiting a loved one in the hospital, wearing a gown and gloves is very important. Clostridium difficile (C diff) spores will spread throughout areas easily and by complying with hospital policies you will keep your family member, friend, yourself, and others safe. Please wash your hands after removing gloves before leaving the room you are visiting, and please wash your hands upon re-entering before new gloves and gown are worn.
ALL “TOUCHABLE (HAND CONTACT)” SURFACES SHOULD BE WIPED
with cleaning agent containing Chlorine Bleach. The CDC cleaning ratio 1:10 solution; 1 cup bleach to 9 cups of water and used on non-porous surfaces over ten minutes and mixed fresh daily for effective cleaning solution OR with a EPA Registered Sporicide/Disinfectant (i.e., Steriplex SD, Clorox Germicidal).
Question: Do Clorox® Disinfecting Wipes contain bleach? NO
Clorox® Disinfecting Wipes, purchased at local markets, are made with a bleach-free formula that’s available in Fresh Scent, Lemon Fresh, Kitchen and Lavender scents so they leave a light, clean scent every time you wipe off a surface. * The “Disinfecting” wipes by Clorox will NOT kill C Diff Spores *
The Clorox Germicidal Wipes and Solution DO have the EPA Registered C Diff Kill.
Clorox Solution has been located and sold through Lowe’s Home Improvement Centers. Check with local stores for this product.
What do I need to do when I go home from the hospital?
Once you are back at home, you can return to your normal daily routine.
Often, the diarrhea will be better or completely gone before returning to home. This makes giving
C. diff to other people much less likely. There are a few things you should do, however, to lower the
chances of developing C. diff infection again or of spreading it to others.
• If you are given a prescription to treat C. diff, take the medicine
exactly as prescribed by your doctor and pharmacist. Do not take half-doses or stop before you run out.
• Hand-washing remains #1 prevention: Take frequent 20 second hand-washing breaks during the day, especially after visiting the bathroom, before and after preparing food, after visiting stores, after visiting the gym, before and after eating, after traveling on public transportation, and often.
Cleaning with a chlorine bleach cleanser will help kill C Diff spores in the home environment.
* If any C. diff symptoms (diarrhea, fever, abdominal cramping) are noticed, please contact the primary physician, healthcare professional and/or seek medical attention at the local clinic/emergency department for assessment and C. difficile stool testing.