Clostridium difficile Infection

Abstract

Preventing Clostridium difficile, the most common cause of health care–associated infections in hospitals and infectious disease death in the United States, is a national priority. Increased rates of infection among low-risk individuals in the community call for community-based prevention efforts to halt the increasing spread of this highly contagious opportunistic infection.

Clostridium difficile, a spore-forming, gram-positive bacillus that causes deadly diarrhea, is the most common cause of health care–associated infections in hospitals and infectious disease death in the United States (Centers for Disease Control and Prevention [CDC], 2015). In 2011, an estimated 453,000 infections and 29,000 deaths in the United States were attributed to C. difficile, costing acute care facilities alone nearly US$5 billion (CDC, 2015; Lessa et al., 2015). Although 300,000 infections were identified as health care–associated, onset for the majority of infections occurred in long-term care facilities or after treatment at a community-based medical or dental facility (Lessa et al., 2015). Emergence of an epidemic strain of C. difficile labeled BI/NAP1/027 contributes to disease in community-based healthy individuals and peripartum women (CDC, 2012). No longer confined to hospitals, community-based prevention efforts are clearly needed to halt the increasing threat of C. difficile infections; prevention is a national priority (CDC, 2015). International efforts are also targeting the spread of this highly contagious opportunistic infection.

Infection risk is greatest for those aged above 65 years, with initial infection, reoccurrence, and death more common in older White females (Lessa et al., 2015). Recent antibiotic use is typical; broad-spectrum antibiotics suppress normal gut bacteria, and intact spores pass through the gastric track, germinate, produce toxins, and cause disease (CDC, 2015). Extended hospital stays, gastrointestinal surgery, serious underlying illnesses, proton pump inhibitors, and immunodeficiency also increase risk (CDC, 2012).

Watery diarrhea, fever, nausea, anorexia, and abdominal pain or tenderness may resolve after discontinuing antibiotics, but pseudomembranous colitis, colon perforation, toxic megacolon, and sepsis may develop (CDC, 2012). Treatment is usually a 10-day course of metronidazole, oral vancomycin, or fidaxomicin. Transmitted by the fecal-oral route, C. difficile is spread predominately by health care providers’ poor hand hygiene. It is difficult to kill spores, which can survive for months on any contaminated inanimate object including commodes and cell phones (CDC, 2015). Fecal contaminated surfaces must be cleaned by washing with soap and water and then disinfected with a sporicidal solution or appropriately diluted household chlorine bleach. Alcohol hand sanitizer will not kill C. difficile spores; avoiding hand contamination through glove use is the cornerstone of prevention (CDC, 2012). Contact precautions, including gloves and gowns, are needed even in home settings for known or suspected C. difficile infections. Nurses and staff in clinics and medical or dental offices must follow recommended infection control practices for symptomatic clients at high risk for C. difficile infections.

Occupational and environmental health nurses can educate workers and their families about C. difficile, risk factors for infection, principles of hand hygiene, and contact precautions. Education about judicious antibiotic use is needed; more than 50% of outpatient antibiotic prescriptions are for viral infections (CDC, 2015). The American Nurses Association (ANA; 2017) collaborated with CDC on the web-based Nursing Infection Control Education Network that provides real-time infection control training to enhance nurses’ confidence about highly contagious diseases. These resources can assist occupational and environmental health nurses recognize at-risk workers, educate the workforce, and improve infection control measures.