Infection Prevention Podcast - Ania Swann
Summary
TLDRIn 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
🌿 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.
🚨 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.
🛡 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.
Mindmap
Keywords
💡C diff
💡Infection Control
💡Spores
💡Hand Hygiene
💡Diarrhea
💡Isolation
💡Personal Protective Equipment (PPE)
💡Traffic Light System
💡Antibiotic History
💡Colitis
💡Toxic Megacolon
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
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