Infection Prevention Podcast - Ania Swann

Summary

In the 'Inside Northumbria' podcast, clinical educator Rachel and specialist infection prevention nurse Anya discuss Clostridioides difficile (C. diff), a bacterium causing severe diarrhea and colitis. They cover its environmental resilience, transmission through ingestion, and infection control measures, emphasizing hand hygiene with soap and water due to C. diff's resistance to alcohol-based sanitizers. The podcast also addresses patient isolation, the importance of a traffic light system for diagnosis, and the potential complications of C. diff, including pseudomembranous colitis and toxic megacolon, highlighting the need for vigilance in patient care.

Takeaways

• 🌐 'C diff' stands for Clostridioides difficile, a bacterium that can cause severe intestinal problems and is resistant to alcohol-based sanitizers.
• 🌱 C. difficile spores can survive in the environment for months, potentially found on surfaces and in soil, posing a risk for infection.
• 🤲 Hand hygiene is crucial in preventing the spread of C. difficile, with liquid soap and water being the preferred method over hand sanitizers.
• 🏥 Staff members should isolate patients with new-onset diarrhea in a timely manner and use personal protective equipment to prevent infection spread.
• 🔍 If a patient develops diarrhea, the medical staff should review their medication and conditions that might contribute to the symptoms.
• 📝 The 'traffic light system' is used to assess patients for C. difficile infection, considering both bowel symptoms and other contributing factors.
• 🚨 Offensive-smelling stools can be a sign of C. difficile infection, prompting the need to contact the infection control team for further action.
• 🧪 A C. diff pathway document outlines the responsibilities of staff in managing and documenting C. difficile cases, with an emphasis on environmental cleaning.
• 📉 The number of C. difficile cases has seen a decrease due to preventative measures but has not been completely eradicated.
• 💔 Complications of C. difficile can include colitis, pseudomembranous colitis, and in severe cases, bowel perforation which can be fatal.
• 📈 There is a current increase in C. difficile cases across the trust and the UK, indicating a broader trend in healthcare organizations.

Q & A

What is the full name of the bacterium commonly known as C diff?

The full name of the bacterium commonly known as C diff is Clostridioides difficile.

How long can C diff spores survive in the environment?

C diff spores can survive in the environment for a number of months and still be active.

How is C diff typically spread?

C diff is typically spread through ingestion, which can occur via contact with a contaminated environment or with hands that have come into contact with contaminated surfaces.

What is the significance of hand hygiene in preventing the spread of C diff?

Hand hygiene is critical in preventing the spread of C diff because the bacterium's spores are resistant to alcohol-based hand sanitizers. Washing hands with liquid soap and water is the recommended method.

What should staff do if they identify a patient with new diarrhea?

Staff should ensure the patient is isolated in a side room in a timely manner, use personal protective equipment, and practice proper hand hygiene.

What is a telltale sign of C diff infection besides diarrhea?

A telltale sign of C diff infection, besides diarrhea, is the production of stools with a distinctive, offensive, and sickly sweet smell.

What is the traffic light system and how does it relate to C diff?

The traffic light system is a method within the organization that prompts staff to assess patients holistically, considering factors like medications and conditions that might contribute to symptoms like diarrhea, which could be indicative of C diff.

What documentation should be completed when a C diff result is obtained?

A C diff pathway, which is a paper copy document outlining the responsibilities of various staff members, should be completed. It includes daily reviews of the patient's condition and monitoring of fluid balance and inflammatory markers.

How often should environmental cleaning be performed for a patient with C diff?

Environmental cleaning should be encouraged at least twice, if not three times daily for a patient with C diff to minimize the bacterial load and spore count in the environment.

What are some potential complications of C diff infection?

Potential complications of C diff infection include severe colitis, characterized by abdominal pain and distension, and in severe cases, toxic megacolon and bowel perforation, which can be fatal.

Is the increase in C diff cases seen in the trust mirrored across the UK and other organizations?

Yes, the increase in C diff cases is not only seen in the trust but also across the UK and other organizations, as reported through mandatory case reporting and national statistics.

Outlines

00:00

🌿 Introduction to C. Difficile Infection

In this introductory segment, Rachel, a clinical educator for infection control, welcomes listeners to the podcast and introduces Anya, a specialist infection prevention and control nurse. They discuss the increase in C. difficile (C diff) cases during the off-season and provide an overview of C diff, a bacterium that produces spores capable of surviving in the environment for months. The spores can be ingested through contact with contaminated surfaces, emphasizing the importance of infection control measures such as hand hygiene. The conversation highlights the resistance of C diff spores to alcohol-based sanitizers, advocating for washing hands with liquid soap and water as the gold standard for prevention.

05:00

🚨 Managing C Diff Infections in Healthcare Settings

This paragraph delves into the management of C diff within healthcare facilities. It discusses the importance of isolating patients with new-onset diarrhea, the use of personal protective equipment, and the critical role of hand hygiene in preventing the spread of C diff. The 'traffic light system' is introduced as a method for assessing when to send stool specimens for testing. The system encourages a holistic review of the patient's condition, considering factors such as antibiotic history and potential contributing medications. The segment also touches on the documentation process for C diff cases, including a C diff pathway that outlines responsibilities for various staff members and the importance of environmental cleaning to manage bacterial load.

10:02

🛡 Complications and National Trends of C Diff Infections

In the final paragraph, the focus shifts to the complications associated with C diff infections, particularly in elderly patients with comorbidities. Complications can range from colitis to more severe conditions like toxic megacolon and bowel perforation, which can be fatal. The discussion also addresses the national trend of increasing C diff cases, noting that while preventive measures have reduced numbers, complete eradication has not been achieved. The segment concludes with an open invitation for queries to the infection control team and a reminder of the availability of microbiologists for out-of-hours support.

Keywords

💡C diff

C diff, short for Clostridioides difficile, is a bacterium that can cause severe diarrhea and more serious intestinal conditions such as colitis. The term is central to the video's theme as it is the focus of the discussion on infection control. In the script, it is mentioned as a bacterium that produces spores, which can survive in the environment for months, posing a challenge in healthcare settings.

💡Infection Control

Infection Control refers to the measures taken to prevent the spread of infectious diseases, especially in healthcare environments. The video discusses various infection control measures, such as hand hygiene and isolation of patients, to manage and prevent the spread of C diff. It is a key concept as it encapsulates the strategies used to handle the bacterium discussed in the script.

💡Spores

Spores are dormant structures produced by certain bacteria, including C diff, which allow them to survive in harsh conditions. In the context of the video, spores are significant because they can remain active in the environment for extended periods, leading to potential infection outbreaks. The script mentions that these spores can be found on various surfaces, emphasizing the importance of environmental cleaning.

💡Hand Hygiene

Hand hygiene is the practice of cleaning one's hands to remove dirt, soil, and pathogens. It is highlighted in the script as a critical infection control measure, especially when dealing with C diff, which is resistant to alcohol-based hand sanitizers. The video emphasizes the use of liquid soap and water for effective hand hygiene in the context of C diff infection.

💡Diarrhea

Diarrhea is characterized by loose, watery stools and is a common symptom of C diff infection. In the script, it is used to identify potential C diff cases, with specific mention of the number of stools within a 24-hour period that would be considered indicative of diarrhea. It is a key symptom that triggers further investigation and isolation measures.

💡Isolation

Isolation in a healthcare setting refers to the separation of patients who have contagious diseases to prevent the spread of infection. The script discusses the importance of isolating patients with suspected C diff in a side room promptly to prevent the bacterium from spreading to other patients.

💡Personal Protective Equipment (PPE)

PPE includes items such as aprons and gloves that are worn by healthcare workers to protect themselves and patients from infection. In the context of the video, PPE is mentioned as a necessary precaution when handling patients with suspected or confirmed C diff infection.

💡Traffic Light System

The Traffic Light System is a metaphor used in the script to describe a protocol or system for assessing and managing patients with symptoms suggestive of C diff infection. It is mentioned as a tool to prompt healthcare workers to consider various factors beyond just the symptoms, such as the patient's medical history and current medications.

💡Antibiotic History

Antibiotic history refers to the record of antibiotics a patient has previously taken. The script points out that the use of antibiotics is a significant risk factor for developing C diff infection. It is used to assess patients for the likelihood of C diff and to inform decisions about treatment and management.

💡Colitis

Colitis is an inflammation of the colon, which can be a complication of C diff infection. In the script, it is mentioned as a potential outcome for patients with severe C diff infection, characterized by severe abdominal pain and distension, and sometimes leading to life-threatening conditions like toxic megacolon.

💡Toxic Megacolon

Toxic megacolon is a serious complication characterized by severe inflammation and dilation of the colon, which can occur in C diff infections. The script describes it as a worst-case scenario where the bowel can perforate, leading to tragic outcomes such as patient death.

Highlights

Introduction to the podcast 'Inside Northumbria' with clinical educator Rachel and specialist nurse Anya discussing infection control.

Anya introduces herself as a specialist in infection prevention and control.

C. diff (Clostridioides difficile) is identified as a spore-forming bacterium causing environmental contamination.

C. diff spores can survive on surfaces for months, posing a significant infection risk.

Infection spread is primarily through ingestion, emphasizing the importance of hand hygiene.

Hand hygiene with liquid soap and water is crucial due to C. diff spores' resistance to alcohol-based sanitizers.

Staff are encouraged to isolate patients with new-onset diarrhea to prevent C. diff spread.

Use of personal protective equipment and aprons is recommended when handling C. diff cases.

The 'traffic light system' is mentioned for assessing and managing potential C. diff cases.

A distinct smell of C. diff stools is a telltale sign prompting further investigation.

Infection control team involvement is advised for comprehensive patient assessment.

The importance of reviewing patient medications and bowel conditions in C. diff diagnosis.

The role of the domestic team in enhanced environmental cleaning for C. diff management.

Daily patient review is essential to monitor fluid balance and prevent complications.

C. diff complications include colitis, pseudomembranous colitis, and potentially life-threatening bowel perforation.

C. diff cases are increasing across the trust and are mirrored in national statistics.

Anya discusses the ongoing challenges in understanding and managing C. diff infections.

The podcast concludes with an invitation for queries and the availability of the infection control team.

Transcripts

[Music]

hey everyone welcome to inside

northumbria a series of podcasts giving

you a chance to hear how we do things

the northumbria week

hello my name is Rachel I'm the clinical

educator for infection control joined

with me today I've got Anya hello Anya

do you want to introduce yourself hi

there Rachel I'm my name is Anne you're

and I'm one of the specialist infection

prevention and control nurses in the

trust I'm very happy to be here with you

this morning and I'm not quite sure how

this will go but hopefully it'll go okay

so I've brought Anya along today to talk

about and see diff obviously from the

trust perspective we are seeing a slight

increase to what would ideally like at

this time of year so Anya what is C diff

okay so C diff otherwise known as

clostridioides difficile which is a bit

of a mouthful it's actually a bacterium

and it produces spores that when they're

excreted into the environment can live

in the environment for a number of

months and still be active so that's

really where the problem lies so they

can live on soft Furnishings hard

surfaces

um it's a bacterium that we find

naturally in the gut but also we do find

it in the environment as well so in soil

Etc and in terms of how it's spread it's

usually ingestion so you would you know

you would actually ingest it via your

mouth either via contact with the with a

contaminated environment or with your

hands actually coming into contact with

contaminated surfaces so that that's why

as we'll probably discussed during the

podcast and there's a few infection

prevention measures which will really

are really critical and really useful

what infection control measures actually

can we do I know obviously on previous

podcasts I've spoken around hand hygiene

is there anything else that we can do

from a trust perspective from a staff

management perspective yeah so I think

there's plenty that we can be doing and

especially staff on the wards can be

really proactive about this so if a

staff member identifies a patient that

they're caring for has developed um you

know new diarrhea in other words that

their patient is having profuse type six

or seven stools and you know three or

more episodes in a 24-hour period is

what we would consider as diarrhea then

you can actually make sure that that

patient is isolated in a side room in a

timely manner and also obviously you use

precautions in terms of personal

protective equipment aprons and gloves

and also hand hygiene is really critical

and when we're talking about hand

hygiene with suspect affected or

confirmed C diff we're really talking

about liquid soap and water that's the

gold standard because you may or may not

know that the hand sanitizer is

alcohol-based and the spores for C diff

actually resistant to alcohol-based

products so that's why we really

reinforce the importance of actually

washing your hands with liquid soap and

water right okie dokie so obviously you

kind of linked in there so we've got a

traffic light system within the

organization what sits within that

traffic light system when should we be

sanding a stool specimen as we said if

you suspect that somebody might have

um C diff because they've developed

diarrhea or the other thing that is a

bit of a Telltale sign is that our

acidif often produces really offensive

smelling

um stools which has a really distinctive

smell and if you've ever smelt it you

you will never forget that smell and

it's sort of almost like a sickly sweet

um smell that you get but if you do get

that then not we would really urge you

to ring the infection control team to

discuss the patient and what we do is we

look at the patient as a whole so what

we don't just look at the bowels we look

at whether the patients on any

medications that might be contributing

to the loose stools are they on any

laxatives and do they have a known

condition that also may be contributing

to the loose stool so I'm thinking you

know if they've got a known bowel

condition for example the other thing is

antibiotic history so antibiotics is a

really

um you know a really big factor in terms

of C diff and we know that if you've had

courses of antibiotics it does increase

your risk of developing C diff so then

we would talk it through with you so um

we would you know ask the pertinent

questions

um we would probably ask you to get the

medical staff to review the patient in

respect of the diarrhea make sure that

it's not something obvious like overflow

you know constipation with overflow

um but then you know I think reviewing

the medications if your patients had you

know lots of laxatives then obviously

we're inducing loose stools so what we

need to do is then review the laxatives

maybe stop them

um for a period and see if the diarrhea

actually improves and if that's the case

then it's probably not infective

diarrhea if the diarrhea persists then

Our advice is going to be to send a

specimen in a timely manner so that we

can identify what the cause of the

diarrhea is potentially and but also

ensuring that the patient is isolated

and that the staff are um doing all the

necessary preventative precautions one

of the other things about the traffic

light system

um is that it just makes you stop and

think

yeah so I think it just makes it just

you know take stock of what's happening

with the patient as a whole rather than

just focusing on one thing documentation

wise or if we'll get a result of C diff

you know what documentation should we be

completing okay so currently we have a C

diff pathway which is a paper copy um

pathway which highlights the

responsibilities of each of the staff on

the ward so it there's some core

responsibilities which is pertinent to

everybody

um but there are some different ones um

specific to medical staff and nursing

staff but also the domestic team and

they're really crucial actually the

domestic team are a key part of the

management of assertive patient because

they actually do the enhanced

environmental cleaning and as I said

before when I spoke about what C diff is

the environment is really important in

terms of how we manage our patients in

terms of minimizing the bacterial load

and this the load of seed of spores

within the environment the patient's in

so we try and encourage at least twice

if not three times daily environmental

cleaning and then the responsibilities

thereafter around the nursing and

medical are a daily review of the

patient so making sure that the

patient's not deteriorating and one of

the things with C diff is that the

patient can have huge amounts of

diarrhea and lose a lot of fluid which

can then potentially lead on to maybe an

acute kidney injury or dehydration so

it's about monitoring fluid balance for

example it's about checking patients

Bloods making sure that we're monitoring

them inflammatory markers and see if

they are rising

um yeah so as I said currently the

pathway is paper copy but we're looking

towards actually putting it

electronically as we are with all of the

trust documentation you know and so

watch this space really it's it's going

to happen soon but obviously we want it

to be in a format that is easy for the

ward teams to use right okey-dokey and

obviously just to emphasize that that

the pathway should also be run alongside

on the end of life care as well

absolutely so it's no doubt you know no

matter which part of the care that that

patient's gone through that it should

run side by side so you kind of brushed

on it there what are the complications

of C diff What could potentially happen

to somebody most of our C diff patients

not exclusively but most of them are

elderly over 65 and often they have

other comorbidities as well so with our

seed of patients if they're toxin

positive particularly implies that

they've got an infection of C diff and

in terms of the effect that it can have

on the bowel it can actually

um produce a colitis picture for the

patient so in other words their bowel

can become really inflamed and they can

often produce a mucousy stools as well

and sometimes even blood in their stools

the signs of complicated patients are

offering if a patient starts

experiencing really bad abdominal pain

and often they get distension as well

and really if you're at that stage with

your patient you need to be querying

whether the patient has got a colitis or

what we call a pseudomebranous colitis

and there's something called toxic

megacolon which is where the bowel

becomes so inflamed due to the C diff

toxins and everything else that's going

on there they can't absorb nutrients

properly and it's just a really

sludgy picture inside the bowel and the

worst case scenario is that the patient

can actually perforate their bowel can

perforate and the most tragic

consequences that they sadly die

that's really sad obviously we are

seeing an increase across the trust at

the moment

um is this you know mirrored across the

UK is it something that we're seeing

across other organizations as well it is

actually yeah so we do um measure the

number of C diff talks in positive cases

that we have in our trust

um because we have to report those as a

mandatory um thing and other all the

other trusts in the country are doing

exactly the same so there is there are

statistics there and we do know what the

national picture is and unfortunately it

is it is starting to um go up again a

few years ago I mean when I first

started in the team we had in excess of

200 280 talks in positive cases so we

have come a long way and obviously the

the trust has implemented a number of

um uh preventative measures and a number

of management things that have

contributed to that number coming down

but unfortunately we've never managed to

eradicate it fully and I think that's

because we don't actually fully

understand everything about diff we know

a lot more than we used to and we

understand a lot more about the risk

factors involved but we still don't

truly understand 100

how how sometimes some patients get it

and others don't and also

um in terms of the risk factors I

mentioned that most patients are over 65

but also we can have some younger

patients as well who can get C diff and

even patients who've never had

antibiotics and it's those sort of

anomalies where we don't really fully

understand the picture well it's been

really interesting so

um I'll close up so thank you very much

Anya that's been fantastic

um yeah if anyone's got any queries then

do feel free to get in touch with the

infection control team you know I've

said it before but we are available and

there's microbiologists available

um out of hours as well if it needs to

be thank you very much okay my pleasure

thanks very much Rachel