2. Gram stain of C. difficile From Public Health Image Library

3.  Watery diarrhea, often foul-smelling  Fever  Loss of appetite  Nausea  Abdominal pain/tenderness

5. Image: http://www.cdiff-support.co.uk/about.htm

7.  Historically uncommon, now epidemic  More resistant to fluoroquinolones  Carries extra toxin known as binary toxin  There is an 18-base pair deletion in the regulatory gene (tcdC) responsible for toxin production. This strain produces 16 times as much toxin A and 23 times as much toxin B in vitro.  More severe disease, higher mortality, more frequent relapses

9.  You will be wearing a gown and gloves to enter the room.  If you are performing a procedure that may splatter respiratory secretions to your face, you will need facial protection-a face shield or goggles and a mask.

10.  Gown first  Mask or respirator  Goggles or face shield  Gloves Extended Contact Precautions Combination of PPE is not the same for all types of precautions. Extended Contact Precautions requires the use of a gown and gloves. Source: CDC Note: clean hands before donning PPE.

11.  Select appropriate type and size  Opening is in the back  Secure at neck and waist  If gown is too small, use two gowns ◦ Gown 1 ties in front ◦ Gown 2 ties in back Source: CDC

12.  Don gloves last  Select proper type and size  Insert hands into gloves  Extend gloves over cuffs of isolation gown

13.  Keep gloved hands away from face  Avoid touching or adjusting other PPE  Remove gloves if they become torn; perform hand hygiene before donning new gloves  Limit surfaces and items touched. Source: CDC

14.  Contaminated-outside front ◦ Areas of PPE that have or are likely to have contact with body sites, materials, or environmental sources where the infectious organism may reside  Clean-inside of gown, outside back of gown, ties on head (mask) and back (gown) ◦ Areas of PPE that are not likely to have been in contact with the infectious organism Source: CDC

15. 1. Gloves 2. Face shield or goggles (if worn). Avoid touching front of goggles or shield to remove. 3. Gown 4. Mask or respirator (if worn). Avoid touching the front of the mask- use ties or elastic to remove. Source: CDC

16.  Grab outside edge near wrist  Peel away from hand, turning first glove inside-out.  Hold in opposite gloved hand.

17.  Slide ungloved finger under wrist of remaining glove.  Peel off from inside, creating a bag for both gloves.  Discard  Clean hands

18. Unfasten ties Peel gown away from neck and shoulder Turn contaminated outside away from inside Fold or roll into a bundle Discard Source CDC

19.  Clean your hands after PPE removal  If your hands become visibly contaminated during the process of PPE removal, wash hands before to continuing to remove PPE.  For Extended Contact Precautions: ◦ You may use alcohol hand sanitizer BEFORE patient contact. ◦ You must use CHG soap and water AFTER contact othertypes of isolation  For all other types of isolation, either hand sanitizer or CHG soap is effective both before and after patient contact.