Clostridium difficile - No Test Required | · PDF file1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Clostridium difficile Elizabeth Boldon,

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Clostridium

difficile

Elizabeth Boldon, RN, MSN

Elizabeth Boldon is a Nurse Education

Specialist at Mayo Clinic in Rochester,

Minnesota. She received a BSN from

Allen College in Waterloo, Iowa in 2002

and an MSN with a focus in education

from the University of Phoenix in 2008.

She has bedside nursing experience in

medical neurology and the neuroscience

ICU.

Abstract

Clostridium difficile infection (CDI) is a major cause of infectious disease

concern in the United States. It is the associated with hospital-acquired

intestinal inflammation and diarrhea and, most commonly, with normal

intestinal flora disruption due to poor prescribing practices of antibiotics. It

has been reported that antibiotics prescribed in hospitals are often

unnecessary or incorrect. Using infection control recommendations and more

careful antibiotic use can prevent clostridium difficile infection. The risk of

CDI associated with antibiotic use and other risk factors, including disease

recognition, treatment and prevention are discussed.

2


Continuing Nursing Education Course Planners

William A. Cook, PhD, Director, Douglas Lawrence, MA, Webmaster,

Susan DePasquale, MSN, FPMHNP-BC, Lead Nurse Planner

Policy Statement

This activity has been planned and implemented in accordance with the

policies of NurseCe4Less.com and the continuing nursing education

requirements of the American Nurses Credentialing Center's Commission on

Accreditation for registered nurses. It is the policy of NurseCe4Less.com to

ensure objectivity, transparency, and best practice in clinical education for

all continuing nursing education (CNE) activities.

Continuing Education Credit Designation

This educational activity is credited for 2 hours. Nurses may only claim credit

commensurate with the credit awarded for completion of this course activity.

Statement of Learning Need

Nurses need to recognize and stay informed of the risk factors, symptoms,

diagnosis, treatment and prevention of clostridium difficile. Importantly, C.

difficile is caused by normal intestinal flora disruption due to poor prescribing

practices of antibiotics. Nurses can identify and educate patients and peers

of the risk of antibiotic prescribing and other risk factors associated with C.

difficile morbidity and mortality.

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Course Purpose

To provide nursing professionals with knowledge to care for patients with

clostridium difficile, and to promote prevention strategies of disease

occurrence and recurrence.

Target Audience

Advanced Practice Registered Nurses and Registered Nurses

(Interdisciplinary Health Team Members, including Vocational Nurses and

Medical Assistants may obtain a Certificate of Completion)

Course Author & Planning Team Conflict of Interest Disclosures

Elizabeth Boldon, RN, MSN, William S. Cook, PhD,

Douglas Lawrence, MA, Susan DePasquale, MSN, FPMHNP-BC –

all have no disclosures

Acknowledgement of Commercial Support

There is no commercial support for this course.

Activity Review Information

Reviewed by Susan DePasquale, MSN, FPMHNP-BC

Release Date: 2/15/2016 Termination Date: 9/30/2018

Please take time to complete a self-assessment of knowledge, on

page 4, sample questions before reading the article.

Opportunity to complete a self-assessment of knowledge learned will be provided at the end of the course.

4


1. Each year, more than _____________ people get sick from C.

difficile.

a. 1/4th million

b. 1/3rd million

c. half million

d. None of the above

2. Complications of C. difficile infections include:

a. dehydration

b. hypotension

c. kidney failure

d. All of the above

3. Standard treatment for C. diff is a _________ day course of

another antibiotic.

a. 5 - 7

b. 10 – 14

c. 20 – 30

d. > 30

4. For more severe and recurrent cases, _____________ , may be

prescribed

a. ampicillin

b. flagyl

c. vancomycin

d. Answers a and b above

5. True/False. Research has shown FMT has a success rate higher

than 50 percent for treating C. difficile infections.

a. True

b. False

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Introduction

Clostridium difficile infection (CDI), also called C. difficile or C. diff, is an

important cause of concern for health professionals in the United States due

the infectious disease morbidity and mortality rates reported with its

occurrence. It has been estimated (in 2011) that CDI had caused almost half

a million infections in the U.S. population. Approximately 83,000 of the

patients who developed CDI experienced at least one recurrence and 29,000

individuals died within 30 days of the initial diagnosis.1

Poor prescribing practices put patients at risk for C. difficile infections. More

than half of all hospitalized patients will receive an antibiotic at some point

during their hospital stay, but studies have shown that 30 - 50% of

antibiotics prescribed in hospitals are unnecessary or incorrect. C. difficile

infections can be prevented by using infection control recommendations and

more careful antibiotic use.1

What Is Clostridium difficile?

Clostridium difficile is a bacterium that can cause symptoms ranging from

diarrhea to life-threatening inflammation of the colon. Illness from C. difficile

most commonly affects older adults in hospitals or in long-term care facilities

and typically occurs after use of antibiotic medications. However, studies

show increasing rates of C. difficile infection among people traditionally not

considered high risk, such as younger, healthier individuals without a history

of antibiotic use or exposure to healthcare facilities. Each year, more than a

half million people get sick from C. diff. In recent years, C. difficile infections

have become more frequent, severe and difficult to treat.2

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Symptoms of Clostridium difficile

Some people carry the bacterium C. difficile in their intestines but never

become sick, though they can still spread the infection. Clostridium difficile

illness usually develops during or within a few months after a course of

antibiotics.2

Mild to moderate infection

The most common symptoms of mild to moderate C. difficile infection are

listed below. These are:

Watery diarrhea three or more times a day for two or more days

Mild abdominal cramping and tenderness

Severe infection

In severe cases, people tend to

become dehydrated and may need

hospitalization. Clostridium difficile

causes the colon to become inflamed

(colitis) and sometimes may form

patches of raw tissue that can bleed

or produce pus (pseudomembranous

colitis). Signs and symptoms of

severe infection include:2

Watery diarrhea 10 to 15 times

a day

Abdominal cramping and pain, which may be severe

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Fever

Blood or pus in the stool

Nausea

Dehydration

Loss of appetite

Weight loss

Swollen abdomen

Kidney failure

Increased white blood cell count

Causes of Clostridium difficile

Clostridium difficile bacteria are found throughout the environment — in soil,

air, water, human and animal feces, and food products, such as processed

meats. A small number of healthy people naturally carry the bacteria in their

large intestine without experiencing ill effects from the infection.

Most commonly associated with healthcare, C. difficile infection occurs in

hospitals and other healthcare facilities where a much higher percentage of

people carry the bacteria. However, studies show increasing rates of

community-associated C. difficile infection, which occurs among populations

traditionally not considered at high risk, such as children and people without

a history of antibiotic use or recent hospitalization.2

Clostridium difficile bacteria is passed in feces and spread to food, surfaces

and objects when people who are infected are negligent in washing their

hands thoroughly. The bacteria produce spores that can persist in a room for

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weeks or months. If someone touches a surface contaminated with C.

difficile, they may then unknowingly swallow the bacteria.

The intestines contain millions of bacteria, many of which help protect the

body from infection. However, when an individual is taking an antibiotic to

treat an infection, the drug can destroy some of the normal, helpful bacteria

as well as the bacteria causing the illness. Without enough healthy bacteria,

C. difficile can quickly grow out of control. Once established, C. difficile can

produce toxins that attack the lining of the intestine. The toxins destroy cells

and produce patches (plaques) of inflammatory cells and decaying cellular

debris inside the colon and cause watery diarrhea.2

Emergence of a new strain

An aggressive strain of C. difficile has

emerged that produces far more toxins than

other strains do. The new strain may be

more resistant to certain medications and

has shown up in people who have not been

in the hospital or taken antibiotics. This

strain of C. difficile has caused several

outbreaks of illness since 2000.2

Risk Factors for Clostridium difficile

Although people — including children — with no known risk factors have

become sick from C. difficile, certain factors increase the risk. These risk

factors are briefly outlined below.

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Taking antibiotics or other medications

Medication-associated risk factors relate to a variety of scenarios. Examples

of medication-associated risk factors include:

Currently taking or having recently taken antibiotics

Taking broad-spectrum antibiotics that target a wide range of bacteria

Using multiple antibiotics

Taking antibiotics for a long time

Taking medications to reduce stomach acid, including proton pump

inhibitors (PPIs)

Staying in a healthcare facility

The majority of C. difficile cases occur

in, or after exposure to, healthcare

settings — including hospitals, nursing

homes and long-term care facilities —

where germs spread easily, antibiotic

use is common and people are

especially vulnerable to infection. In

hospitals and nursing homes, C. difficile

spreads mainly on hands from person

to person, but also on cart handles,

bedrails, bedside tables, toilets, sinks,

stethoscopes, thermometers — even

telephones and remote controls.2

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Having a serious illness or medical procedure

Having a serious illness, such as inflammatory bowel disease or colorectal

cancer, or a weakened immune system as a result of a medical condition or

treatment (such as chemotherapy), cause people to be more susceptible to a

C. difficile infection. The risk of C. difficile infection is also greater in those

who have had abdominal surgery or a gastrointestinal procedure.

Older age is also a risk factor for C.

difficile infection. In one study, the risk

of becoming infected with C. difficile was

10 times greater for people age 65 and

older compared with younger people.

After having a previous C. difficile

infection, the chances of having a

recurring infection can be up to 20

percent, and the risk increases further

with every subsequent infection.2

Diagnosis of Clostridium difficile

Medical providers often suspect C. difficile in anyone with diarrhea who has

recently taken antibiotics or when diarrhea develops a few days after

hospitalization. In such cases, the following tests may be performed:

Stool tests

Toxins produced by C. difficile bacteria can usually be detected in a sample

of stool. Several main types of lab tests exist, and they include:

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Enzyme immunoassay:

Most labs use the enzyme immunoassay (EIA) test, which is faster

than other tests, but is not sensitive enough to detect many infections

and has a higher rate of falsely normal tests.

Polymerase chain reaction:

This sensitive molecular test can rapidly detect the C. difficile toxin B

gene in a stool sample and is highly accurate. It is now being adapted

by several laboratories and becoming more widely available.

Cell cytotoxicity assay:

A cytotoxicity test looks for the effects of the C. difficile toxin on

human cells grown in a culture. This type of test is sensitive, but it is

less widely available, more cumbersome to do and requires more than

24 to 48 hours for test results. Some hospitals use both the EIA test

and cell cytotoxicity assay to ensure accurate results.

Testing for C. difficile is unnecessary in the absence of diarrhea or watery

stools.2

Colon examination

In rare instances, to help confirm a diagnosis of C. difficile infection, a care

provider may examine the inside of the colon. A colonic examination,

through a flexible sigmoidoscopy or colonoscopy procedure, involves

inserting a flexible endoscope with a small camera on one end into the colon

to look for areas of inflammation and pseudomembranes. This procedure

allows the endoscopist to remove tissue samples through biopsy or snare

instruments for laboratory (pathology) testing.

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Imaging tests

If a medical provider is concerned about possible complications of C. difficile,

he or she may order an abdominal X-ray or a computerized tomography

(CT) scan, which provides images of the colon. The scan can detect the

presence of complications such as thickening of the colon wall, expanding of

the bowel, or more rarely, a perforation in the lining of the colon.

Complications of Clostridium difficile

Complications of C. difficile infections include the following conditions.2

Dehydration:

Severe diarrhea can lead to a significant loss of fluids and electrolytes.

This makes it difficult for the body to function normally and can cause

severe hypotension.

Kidney failure:

In some cases, dehydration can occur so quickly that kidney function

rapidly deteriorates (kidney failure).

Toxic megacolon:

In situations of toxic megacolon, the affected patient becomes unable

to expel gas and stool, causing the colon to become greatly distended

(hence, the term megacolon). Left untreated, the colon can rupture,

causing bacteria from the colon to enter the abdominal cavity. A

ruptured colon requires emergency surgery and may be fatal.

Bowel Perforation:

A bowel perforation is rare and results from extensive damage to the

lining of the large intestine. A perforated bowel can spill bacteria from

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the intestine into the abdominal cavity, leading to a life-threatening

infection (peritonitis).

Death:

Even mild to moderate C. difficile infections can quickly progress to a

fatal disease if not treated promptly.

Treatment Of Clostridium difficile

The first step in treating C. difficile is to stop taking the antibiotic that

triggered the infection, when possible. Depending on the severity of the

infection, treatment may include the following medical and surgical

interventions.

Antibiotics

Ironically, the standard treatment for C. difficile is a 10 - 14 day course of

another antibiotic. These antibiotics keep C. difficile from growing, which

treats diarrhea and other complications.

For mild to moderate infection, medical providers usually prescribe

metronidazole (Flagyl), taken by mouth. Metronidazole is not approved by

the U.S. Food and Drug Administration (FDA) for C. difficile infection, but has

been shown to be effective in mild to moderate infection. Side effects of

metronidazole include nausea and a bitter taste. For more severe and

recurrent cases, vancomycin (Vancocin), also taken by mouth, may be

prescribed.

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Another oral antibiotic, fidaxomicin (Dificid), has been approved to treat C.

difficile. In one study, the recurrence rate of C. difficile in people who took

fidaxomicin was lower than among those who took vancomycin. However,

fidaxomicin costs considerably more than metronidazole and vancomycin.

Common side effects of vancomycin and fidaxomicin include abdominal pain

and nausea.2

Surgery

For people with severe pain, organ failure

or inflammation of the lining of the

abdominal wall, surgery to remove the

diseased portion of the colon may be the

only option. Recurrent infection and

situations when surgery may be

considered are outlined below.

Recurrent infection

Up to 20 percent of people with C. difficile

get sick again, either because the initial infection never went away or

because they're reinfected with a different strain of the bacteria. But after

one or more recurrences, rates of further recurrence increase up to 65

percent.2

The risk of recurrence is higher for the following individuals.

People older than 65

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Those taking other antibiotics for a different condition while being

treated with antibiotics for C. difficile infection

Those having a severe underlying medical disorder, such as chronic

kidney failure, inflammatory bowel disease or chronic liver disease.

Medical Treatment for Recurrent CDI

The medical treatment for recurrent C. difficile infection may include the

following interventions.

Antibiotics

Antibiotic therapy for recurrence of C. difficile infection may involve one or

more courses of a medication (typically vancomycin), a gradually tapered

dose of medication or an antibiotic given once every few days, a method

known as a pulsed regimen. For a first recurrence, the effectiveness of

antibiotic therapy is around 60 percent and further declines with each

subsequent recurrence.

Fecal microbiota transplant (FMT)

Also known as a stool transplant, fecal microbiota transplant, or FMT, is

emerging as an alternative strategy for treating recurrent C. difficile

infections. Though not yet approved by the FDA, clinical studies of FMT are

currently underway.

Fecal microbiota transplant restores healthy intestinal bacteria by placing

another person's (donor's) stool in the colon, using a colonoscope or

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nasogastric tube. Donor stools are carefully and repeatedly screened for

parasites, viruses, bacteria and certain antibodies before being used for an

FMT. Research has shown FMT has a success rate higher than 90 percent for

treating C. difficile infections. One small, randomized, controlled trial

stopped early because the results were so positive, with a 94 percent

success rate overall.2

Probiotics

Probiotics are organisms, such as

bacteria and yeast, which help restore a

healthy balance to the intestinal tract.

Yeast called Saccharomyces boulardii, in

conjunction with antibiotics, might help

prevent further recurrent C. difficile

infections.

Prevention Of Clostridium difficile

Prevention of C. difficile transmission is especially challenging because the

organism forms spores, which can persist on environmental surfaces for

months and are resistant to commonly used hospital cleaning agents and

alcohol-based hand gels. Thus, prevention and control of C. difficile requires

a number of interventions. This was illustrated in a report of a C. difficile

hypervirulent strain outbreak; the outbreak was successfully controlled with

introduction of successive interventions and through the guidance of ongoing

surveillance.

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Statewide programs and national initiatives emphasizing public reporting,

antibiotic stewardship, and infection control measures have also

demonstrated successful prevention.3

To help prevent the spread of C. difficile, hospitals and other healthcare

facilities follow strict infection-control guidelines. A detailed practice

recommendation for prevention of C. difficile infection in acute-care hospital

settings from the Society for Healthcare Epidemiology of America and the

Infectious Diseases Society of America is available. The recommendations of

each are summarized briefly here.

Surveillance

Rates of C. difficile infection should be tracked using standard surveillance

definitions and be grouped into three hospital facility (HCF) and community

categories: (1) HCF-onset, HCF-associated; (2) community-onset, HCF-

associated; and, (3) community-associated. Such data can be compared

with other facilities and used to evaluate trends within the same facility.

Rising rates or rates above published benchmarks should prompt further

investigation and intervention.

Since 2013, all United States hospitals participating in the Centers for

Medicare & Medicaid Services' Inpatient Prospective Payment System Quality

Reporting Program are required to report facility-wide C. difficile events

using the National Healthcare Safety Network (NHSN); and, public reporting

of hospital rates began in 2014 at the Hospital Compare website. As of 2015,

all long-term acute care hospitals are required to report facility-wide C.

difficile events.3

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Prevention Strategies

Early detection and isolation

Early detection of C. difficile with rapid implementation of contact

precautions is essential for preventing transmission. It requires vigilant

screening for new onset diarrhea in patients at risk and rapid, accurate

testing.

Contact precautions

Patients with suspected or proven C. difficile infections should be placed on

contact precautions, including assignment to a single room with dedicated

toileting facilities or cohorting with other infected patients. Gloves and

gowns should be donned upon room entry and removed prior to exiting the

room. When cohorting is necessary, gowns and gloves should be removed

and hand hygiene performed when moving from one patient to the other. It

may be reasonable to continue contact precautions beyond the duration of

diarrhea, since persistent stool shedding of C. difficile spores is common;

further study is needed on this.3

Hand hygiene

Healthcare personnel should wash their hands with soap and water when

caring for C. diff patients. This is particularly important in the setting of a C.

difficile outbreak. Alcohol-based hand rub (ABHR) does not eradicate C.

difficile spores.

Hand washing with soap and water involves vigorous mechanical scrubbing

and rinsing, so it is more effective than ABHR for physical removal of

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bacterial spores. However, bacterial spore removal through soap and water

hand washing is less effective than ABHR inactivation of vegetative (i.e.,

non-spore forming) bacteria. Thus, adherence to glove use in the care of

symptomatic patients is critically important for preventing transmission of C.

difficile.

Patients with C. difficile infection should also be encouraged to wash hands

with soap and water. In particular, patients should wash their hands after

using the commode, before eating, and when hands are visibly soiled.3

Environmental Cleaning

Clostridium difficile spores can survive on dry surfaces for up to several

months and resist killing by standard disinfectants. Therefore, careful

attention to environmental cleaning is critical for reducing surface

contamination. One study on a bone marrow transplant unit noted that

switching to 1:10 hypochlorite solution from quaternary ammonium was

effective for reducing C. difficile infection rates, from 8.6 to 3.3 cases per

1000 patient-days.3

A disinfectant with a C. difficile sporicidal label that has been registered with

the Environmental Protection Agency (EPA) should be considered for

disinfection of patient rooms and bathroom. Some sporicidal agents can

cause caustic damage to equipment surfaces and serve as an irritant for

patients and healthcare personnel. These issues should be considered in the

selection and implementation of such agents in healthcare facilities as well

as other public settings.

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Multiuse medical equipment such as blood pressure cuffs, stethoscopes, and

thermometers can serve as vectors for transmission of C. difficile. When

possible, disposable equipment should be used; otherwise, such equipment

should be dedicated to a single patient with C. difficile infection. Equipment

that must be shared between patients should be cleaned and disinfected

with a sporicidal agent between uses.3

Chlorhexidine Bathing

Chlorhexidine (CHG) bathing may reduce hospital-acquired C. difficile. This

was illustrated in a study including administration of more than 68,000 CHG

baths over an 18-month period, during which the incidence of C. difficile

decreased with bathing daily or three times weekly compared with a one-

year baseline observation period.3

Antibiotic Stewardship

Administration of antibiotics disrupts the intestinal microbiota and has been

definitively linked to both colonization and disease caused by C. difficile.

Antibiotic use increases the risk for developing C. difficile by 7- to 10-fold

during and up to one month after treatment and by approximately threefold

for two months thereafter. Targeted restriction of a particular antibiotic

agent or class of agents can facilitate control of hospital outbreaks and

reduce C. difficile rates in the community.3

Antibiotics frequently associated with increased C. difficile risk include

clindamycin, fluoroquinolones, cephalosporins, and penicillins. These are

outlined briefly below.

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Clindamycin

Clindamycin restriction has been followed by rapid reductions in C. difficile

cases in several outbreaks. Similar findings have been observed in outbreaks

caused by the highly clindamycin-resistant J strain. In one study, for

example, a policy requiring infectious disease physician approval for

clindamycin use led to reduction in CDI cases (from 11.5 to 3.3 cases per

month).3

Fluoroquinolone

Fluoroquinolone use has been associated with outbreaks caused by the

hypervirulent NAP1/BI/027 strain. Restriction of all fluoroquinolones may be

required for effective control in such circumstances. In one study,

elimination of fluoroquinolone use was associated with a reduction in C.

difficile cases and in the proportion of cases due to the NAP1/BI/027 strain.

Third-generation Cephalosporins

Restriction of third-generation cephalosporins has been successful in

reducing C. diff rates. Other studies have noted associations between

formulary restrictions and reduced C. difficile rates by limiting antibiotics to

penicillin, trimethoprim-sulfamethoxazole, and aminoglycosides in the

setting of an outbreak.

Avoiding Gastric Acid Suppression

Whenever possible, gastric acid suppression should be avoided. Proton pump

inhibitors are a widely used medication to control symptoms of gastric

22


hyperacidity and reflux, which has led to adverse effects associated with C.

difficile.

Summary

The average human digestive tract is home for as many as 1,000 species of

microorganisms. Most of them are harmless - or even helpful - under normal

circumstances. But when something upsets the balance of these organisms

in the gut, otherwise harmless bacteria can grow out of control and cause

illness. One of the worst offenders is the C. difficile bacterium. As the C.

difficile bacteria overgrow they release toxins that attack the lining of the

intestines, causing a potentially fatal condition.

This article has described this condition, as well as the symptoms, causes,

risk factors, diagnosis, complications, treatment and prevention. Clostridium

difficile is a serious, potentially life-threatening infection that can be treated

and prevented by careful infection control practices.

Please take time to help NurseCe4Less.com course planners evaluate

the nursing knowledge needs met by completing the self-assessment of Knowledge Questions after reading the article, and providing

feedback in the online course evaluation.

Completing the study questions is optional and is NOT a course requirement.

23


1. Approximately _________ of patients who developed C.

difficile experienced at least one recurrence:

a. 25,000

b. 40,000

c. 65,000

d. 83,000

2. Studies show that _________ % of antibiotics prescribed in

hospitals are unnecessary or incorrect.

a. 15 – 20

b. 25 – 35

c. 30 – 50

d. > 50

3. Each year, more than _____________ people get sick from C.

difficile.

a. 1/4th million

b. 1/3rd million

c. half million


4. Signs and symptoms of severe C. difficile infection include:

a. fever

b. blood or pus in the stool

c. dehydration and weight loss

d. All of the above

24


5. The antibiotics that most often lead to C. difficile infections

include:

a. fluoroquinolones

b. cephalosporins

c. clindamycin and penicillins

d. All of the above


a. dehydration

b. hypotension

c. kidney failure

d. All of the above

7. For mild to moderate infection, medical providers usually

prescribe

a. Penicillin

b. Vancomycin

c. Metronidazole (Flagyl)

d. Either a or b above

8. ___________ of people with C. difficile get sick again

a. 10 percent

b. 20 percent

c. 30 percent

d. 50 percent

25


9. After one or more recurrences, rates of further recurrence of C.

difficile increase up to ________________.

a. 20 percent

b. 35 percent

c. 50 percent

d. 65 percent

10. True/False. The goal of FMT is to restore healthy intestinal

bacteria.

a. True

b. False

11. Research has shown FMT has a success rate higher than ______

percent for treating C. difficile infections.

a. 35

b. 50

c. 90


12. Suspected or proven C. difficile cases should be placed on

_____________

a. isolation

b. contact precaution

c. reverse isolation

d. Answers a and c above

26


13. C. difficile spores can survive on dry surfaces for up to

a. Days

b. Weeks

c. Several months


14. True/False. Alcohol-based hand rub (ABHR) eradicates C.

difficile spores.

a. True

b. False

15. Removal through soap and water hand washing is less effective

than ABHR inactivation of vegetative (i.e., non-spore forming)

bacteria.

a. True

b. False

Correct Answers:

1. Approximately _________ of patients who developed C. difficile

experienced at least one recurrence:

Correct Answer: 83,000

2. Studies show that _________ % of antibiotics prescribed in hospitals

are unnecessary or incorrect.

Correct Answer: 30 – 50

3. Each year, more than _____________ people get sick from C. difficile.

Correct Answer: half million

27


4. Signs and symptoms of severe C. difficile infection include:

Correct Answer: All of the above

5. The antibiotics that most often lead to C. difficile infections include:




7. For mild to moderate infection, doctors usually prescribe

Correct Answer: Metronidazole (Flagyl)

8. ___________ of people with C. difficile get sick again

Correct Answer: 20 percent

9. After one or more recurrences, rates of further recurrence of C. difficile

increase up to ________________.

Correct Answer: 65 percent

10. True/False. The goal of FMT is to restore healthy intestinal bacteria.

Correct Answer: True

11. Research has shown FMT has a success rate higher than ______

percent for treating C. difficile infections.

Correct Answer: 90

28


12. Suspected or proven C. difficile cases should be placed on

_____________

Correct Answer: contact precaution

13. C. difficile spores can survive on dry surfaces for up to

Correct Answer: Several months

14. True/False. Alcohol-based hand rub (ABHR) eradicates C. difficile spores.

Correct Answer: False

15. Removal through soap and water hand washing is less effective than

ABHR inactivation of vegetative (i.e., non-spore forming) bacteria.

Correct Answer: True

29


References Section

The reference section of in-text citations include published works intended as

helpful material for further reading. Unpublished works and personal

communications are not included in this section, although may appear within

the study text.

1. Clostridium difficile infection (2015). Centers for Disease Control and

Prevention. Retrieved September 10, 2015 from www.cdc.gov

2. C. difficile infection (2013). Mayo Foundation for Medical Education and

Research. Retrieved September 18, 2015 from www.mayoclinic.org

3. Gould, C. & McDonald, L.C. (2015.) Clostridium difficile infection:

Prevention and control in Calderwood, S.B. (Ed.), UpToDate. Waltham,

Mass: UpToDate. Retrieved September 19, 2015 from www.uptodate.com

Additional Helpful Resources:

C diff. (2015.) WebMD. Retrieved September 4, 2015 from www.webmd.com

Kelly, C.P. & Lamont, J.T. (2015.) Clostridium difficile in adults: Treatment

in Calderwood, S.B. (Ed.), UpToDate. Waltham, Mass: UpToDate. Retrieved

September 1, 2015 from www.uptodate.com

http://www.cdc.gov/

http://www.mayoclinic.org/

http://www.uptodate.com/

http://www.webmd.com/

http://www.uptodate.com/

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Clostridium difficile - No Test Required | · PDF file1 nursece4less.com nursece4less.com nursece4less.com nursece4less.com nursece4less.com Clostridium difficile Elizabeth Boldon,