1. Clostridium Difficile (C.diff): Fast Facts

2. What is Clostridium difficile (C. diff)? C. diff is a bacteria that lives in the intestinal tract of about 5% of healthy adults C.diff-associated disease (CDAD) occurs when the normal intestinal flora is altered which allows the bacteria to grow and produce disease causing toxin. CDAD is sometimes called antibiotic associated diarrhea

3. What are the main clinical symptoms of CDAD? Common symptoms include watery diarrhea (sometimes with blood or pus), fever, loss of appetite, nausea, and abdominal pain. Complications can include pseudomembranous colitis, toxic megacolon, perforations of the colon, sepsis, and sometimes death.

4. How is C. diff transmitted? C. diff is shed in feces and can contaminate high contact surfaces such commodes, thermometers, bed-side tables, etc. C.diff is often spread to patients on the hands of health care workers or other people who touch a contaminated surface.

6. Who gets CDAD? Anyone taking antibiotics – very few people who are not on antibiotics get CDAD Persons with inflammatory bowel diseases Persons who have had gastrointestinal surgery Persons on chemotherapy

7. Diagnosis and Treatment Residents with diarrhea should have a stool specimen tested for C.diff. Testing is not recommended for people with no symptoms (i.e. screening or “test for cure”) DO NOT USE ANTI-DIARRHEALS Treatment:  Stop antibiotics, if possible (23% of cases resolve in 2-3 days)  If diarrhea continues, try Flagyl or Vancomycin

8. Why all the recent attention? Reports of CDAD disease have increased, noting more severe disease and an associated increase in mortality. The increased rates and/or severity of disease may be caused by changes in antibiotic use, changes in infection control practices, or the emergence of a new strain of C. difficile- associated disease with increased virulence and/or antimicrobial resistance.

9. How can CDAD be prevented in our facility? Use antibiotics judiciously Use Contact Precautions for patients with CDAD:  If possible, place these patients in private rooms or place in rooms (cohorted) with other patients with C. difficile-associated disease.  Use gloves when entering patients’ rooms and during patient care.  Use gowns if soiling of clothes is likely.  Dedicate equipment whenever possible. If not possible, disinfect equipment between patients.  Precautions should be continued until diarrhea has ceased.  Wash hands with SOAP and WATER before and after caring for patients.

10. How can CDAD be prevented in our facility (cont.)? Implement an environmental cleaning and disinfection strategy:  Use an Environmental Protection Agency (EPA)- registered hypochlorite-based disinfectant for environmental surface disinfection after cleaning in accordance with label instructions; generic sources of hypochlorite (e.g., household chlorine bleach) also may be appropriately diluted and used. (Note: alcohol-based disinfectants are not effective against C. difficile and should not be used to disinfect environmental surfaces.)

11. A Word on Reporting Facility based reporting January 1, 2006- December 31, 2006 Case Definitions:  Health Care-Associated (Initial): Positive laboratory diagnostic test, endoscopy or biopsy >48 hours after admission to a health care facility.  Health Care-Associated (Recurrent): Subsequent positive laboratory diagnostic test, endoscopy or biopsy in an individual with a previous health care-associated positive within the prior 6 months. A subsequent infection which occurs >6 months after an initial infection is also classified as an initial infection.

12. Reporting (cont.) Patient Days Reporting  Reported monthly  Total Patient Days = Sum of the daily census over the entire month Ex. 12 on the 1 st + 12 on the 2 nd + … + 13 on the 31 st = Total Patient Days for the Month

13. Further Recommendations Form an Infection Control Committee Post signs reminding staff, visitors, and residents to wash their hands Provide inservices for staff on infectious disease and control measures

14. Reportable Infectious Diseases in Ohio Refer to the list of reportable diseases and the Northeast Ohio Communicable Disease Report form in your packet. Cuyahoga Central Disease Reporting:  phone: 216-201-2080  fax: 216-676-1316

15. Educational Resources ODH will be offering infection control courses through APIC (EPI 101 & EPI 201) Courses will take place in Toledo, Columbus, and Cambridge Go to www.apic.org for course descriptions Dates and times will be sent out later

16. Hospital C.diff Rates www.odh.state.oh.us Initial Rate (cases per 10,000):  Jan - 8  Feb - 8  Mar - 7  Apr - 8  May – 8  June – 7 Recurrent Rate (cases per 10,000):  Jan - 2  Feb - 2  Mar - 2  Apr - 2  May – 2  June - 2

17. Add Safe Environment Info

18. Thank you for your time and attention. www.ccbh.net 216.201.2020 (option 2)