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ADVANCE Perspective: Nurses

Don't Miss a Step: What Every Nurse Can Do to Help Stop C.diff

Published June 4, 2012 10:26 AM by Chuck Holt

It all started with a missed step. The bottom step of a stairway at my brother's house that is, which my mom completely missed one morning about 18 months ago causing her to land funny and break her left ankle. 

At 75, and having fought a 30-year battle with rheumatoid arthritis, the injury took on added significance. Painful rehab alleviated only by mind-bending painkillers awaited her. She'd been in this sort of jam before during the past 10 years, including a broken shoulder and more recently a broken hip. She was already dreading what was ahead.

Then the really bad stuff happened...

Mom had worked as a telephone operator for 17 years in the same hospital where she would have her ankle surgery. Night shifts, swing shifts, early morning shifts, she'd done it all with hardly a sniffle while raising my three brothers and me. The notion she would get sick from this relatively brief stay at the venerable old Midwestern facility, let alone pick up a potentially fatal MRSA infection, was unthinkable even to me - at first.

Mom hadn't been on any antibiotics in nearly a year prior to going in for ankle surgery, however, and after editing dozens of ADVANCE articles on HAIs , and following the personal experience with C. diff chronicled by our nurse blogger Pat Veitenthal, BSN, RN, who contracted C. diff  shortly after her mother died from it last year, I had my suspicions about what was going on. It was fairly easy to piece together when and where Mom had been infected with clostridium difficile.

Still, Mom continued to profess her doubts that the old hospital she'd grown to see as a second home would actually make her sick; her brand of loyalty is pretty tough to shake like that. But she's starting to come around. Severe diarrhea as often as 6 times daily; crushing fatigue; rapid weight loss; four re-hospitalizations; and a prolonged sense of helplessness will change a person's perspective.

Not to mention facing the prospect of undergoing a fecal transplantation.  Yes, that's right, a fecal transplant, or, technically-speaking, fecal microbiota therapy (FMT), which sounds just as gross (it's just not easy to soft-soap a word like "fecal").

The procedure appears to work however, and as often as 91 percent of the time, according to a study presented last fall at the American College of Gastroenterology (ACG) annual scientific meeting. The idea is to take stool from a healthy individual and get it into the colon of the sick person, banking that the good bacteria will take hold in the recipient and fight off the C. diff once and for all.

For the study unveiled at ACG, the FMTs reportedly were done by colonoscopy, a common method (although there are others, e.g., inserting the healthy stool up the nose of the infected patient). At the 3-month mark, 70 of 77 patients were diarrhea free, which researchers considered a treatment success. Diarrhea resolved, on average, in 6 days, and sometimes in only 3 days following the FMT. Fatigue went away in about a month. No complications or side effects were reported.

"Fecal transplantation is a highly effective, well tolerated and safe form of therapy for this traditionally difficult infection," one of the lead researchers for the study, Lawrence Brandt, MD, emeritus, chief of gastroenterology at Montefiore Medical Center, Bronx, NY, told WebMD.

Just last week, Mom's infectious disease specialist at the vaunted Research Medical Center in Kansas City, MO, decided her FMT could wait a little longer as the latest round of vancomyacin has kept the C. diff at bay for some time now. I'm skeptical because the C. diff has returned each time she's been taken of the drug; however, the doctor's 12-year-old daughter also has C. diff, so I figure he has added interest. I'll keep those of you interested posted on her progress with this blog.

Meanwhile, something every nurse can do is to make sure you don't miss an infection-prevention step, and more specifically, the six steps CDC recommends nurses take to help eliminate C. diff and other HAIs. The steps include: questioning the patient about antibiotic use; ordering a C. diff test if a patient reports diarrhea soon after taking antibiotics; disinfecting every patient's room; protecting yourself with gloves, etc.; isolating infected patients; and alerting other facilities where an infected patient may be transferred or came from.  

Of course, sometimes it can be hard for nursing professionals on the frontlines to remember all of these steps in the heat of the moment.

To help nurses remember what to do when C. diff presents itself, Clorox Healthcare has developed a C. diff prevention visual reference guide, or infographic, based on the CDC recommendations. To view or download free the infographic to share with your nursing team and auxillary staff, visit the Clorox Healthcare's Scribd account at: http://www.scribd.com/doc/92754590/Six-Steps-to-C-difficile-Prevention.

For even more information and a bevy of free resources on HAI prevention, visit http://www.cloroxprofessional.com/industry/health/. (Also, be sure to regularly visit the ADVANCE for Nurses Infection Control Center for feature articles, quizzes on your infection control knowledge and more.)  

I implore you to visit the Clorox Healthcare campaign's web pages, even if only as a refresher, so you don't miss a step in fighting HAIs. The step you remember to take might just be the one that keeps somebody like my mom from getting clobbered by C. diff.

3 comments

Wouldn't it be great if you could stop the spread of C. difficile at the front door? Since carriers can

April 30, 2013 12:46 PM

I don't know about Illinois, sorry, but I believe it's prttey standard that you can take your board exams as many times as it takes.It is up to your employer to decide if they want to continue to employ people while waiting for them to pass   and it is not uncommon for people to fail at least once. It is common courtesey to hold a nursing position at least until they test a second time. It's not unheard of for them to hold it longer. But obviously if you think you are suffering and that your employer's policies are unreasonable, you should voice your concerns. Are you part of a union? You could talk to a union rep for support also.Good luck!

Nicolle Nicolle, WzgaBSDhHUawi - cxcMWgCxIkOK, NxqIuKCoQcw October 23, 2012 9:02 PM
iRjagYHCz WI

C -diff in May 2012...3 different antibiotics with Vanco successfully clearing up this terrible infection.  Now taking Florastor and Culturelle each twice daily (probiotics)...used and continue to use Clorox on any cleanable hard surface..light switches, computer keyboard, door knobs, sink areas, phones....car steering wheel.   Yes, Ihave become a germaphobe!!  Praying that the spores are dead.  Had been on antibiotic in April for infected chigger bites.  Lesson learned...!!

Kathy, Endocrinology - Diabetes Educator..RN, CDE, South Lake Endocrinology June 22, 2012 8:48 AM
Clermont FL

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