Clostridium difficile, or c-diff, is a growing problem in health care facilities. C-diff is a bacteria known for causing severe diarrhea. In severe cases, the bacteria may be life-threatening to the individual. The condition normally develops in individuals who have recently used antibiotics. It is most commonly seen in older individuals who are hospitalized or are residents of a long-term care facility. One significant issue with the bacteria is that, unlike most bacteria, it is not destroyed by alcohol-based hand gels or foams. An individual must thoroughly wash his or her hands to prevent the spread of this infection (Mayo Clinic, 2015).
This condition is currently a concern in the facility where I work. Normally, there are 0-2 probably transmissions from patient to patient. However, in January, there were thirteen probably patient to patient transmissions on eight different units. The conditions has significant adverse outcomes on the patient population and also on the health care facility. Since it is a hospital-acquired condition, the Centers for Medicaid and Medicare Services will not reimburse the facility for the cost of treating these cases. Furthermore, and more importantly, it leads to significant adverse outcomes for the patients, such as increased mortality and morbidity. This is particularly true for elderly individuals. Eighty-three percent of all gastroenteritis deaths occur in those over sixty-five years of age. Furthermore, the number of deaths from c-diff increased five-fold over a short period of time. In 1999-2000, there were ten deaths per 1 million person-years. However, in 2006-2007, there were 48 deaths per 1 million person-years (Hall, Curns, McDonald, Parashar, et al, 2012, p. 216).
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There are a number of possible issues that may have resulted in the increase of cases in this facility. One must question if the patients who are identified as positive for the bacteria are being properly isolated. PPE must be properly used in these cases. It is also important to question the possible increased use of alcohol based foams for cleaning hands, rather than hand washing. Alcohol-based foams and gels have been shown to be ineffective against this potentially deadly pathogen. The spores of c-diff are not killed by alcohol. Antimicrobial soap also does not have an impact on them. Rather, the act of handwashing is important because it results in the physical removal of the spores due to the friction of the hands and the running of the water (Kundrapu, Sunkesula, Jury, Deshpande, et al, 2014, p. 204). One must also question if the nurse quickly identified that the patient had diarrhea; once this condition is identified, isolation procedures are enacted as a precautionary measure. If the nurse does not identify the condition that leads to these precautionary measures, there is a possibility that other health care professionals will not be made aware of the need for physical handwashing, as opposed to alcohol cleaners.
There are a number of potential solutions to this problem. Firstly, a policy made be instituted that all health care professionals must wash their hands with soap and water at least twice an hour. It must be noted that alcohol based sanitizers are quicker and easier to use; the proliferation of dispensers at facilities also increase the ease of their use. As a result, proper handwashing may suffer. If all individuals are encouraged to wash their hands more often and to not use the gels as much, this may help to change the policy. Furthermore, the housekeeping staff may consider changing their cleansers to bleach-based products. Bleach is the most effective way to deactivate the spores in cleaning. Any room that is cleaned after a patient leaves should be thoroughly cleaned in a bleach-based solution. Other possible solutions include expanding the diarrhea protocol. Patients who are complaining of symptoms consistent with diarrhea, such as abdominal cramping, should be isolated until it is determined if they have gastroenteritis. It is important, of course, to evaluate the efficacy of these possible solutions before they are implemented.
