Sodium Difficile Research Paper

Clostridium Difficile

Anna Kay Mew
BIOL 210 Summer 2013
Frank D Boone
June 11, 2013

Clostridium Difficile The healthcare professional can expect to encounter various conditions within their scope of experience. Clostridium difficile represents one of the most common and challenging nosocomial infections that can cause life-threatening complications such as hypervolemia, sepsis, pain, and peritonitis (Grossman and Mager 155). The recognition, diagnosis, treatment and inhibition of transmission of this bacterium are imperative in order to limit infection and prevent death. “Clostridium difficile is a gram positive, spore forming anaerobic bacillus, which may or may not carry the genes for toxin A-B production” (Patel 102). In the 1930’s, Hall and O’Toole first identified C. difficile as plentiful normal bacterial flora in the feces of healthy infants. Initially, it was not considered a pathogen. However, by 1978, researchers recognized that toxins released by Clostridium were found in the fecal matter of patients with antibiotic associated diarrhea and concluded it as the cause of the infection (Keske and Letizia 329). The fecal-to-oral bacterial route transmits this particular bacterium. The ability of C. difficile to develop spores, enable this organism to persevere in the most extreme environmental
settings. The spores can survive on common surfaces for months, including bedding, toilets and skin. The resistant quality of this bacterium increases its transmission and reinoculation rate. Chronic inflammation in the intestines can be a result of the ingestion of C. difficile. The spores proliferate, and produce toxins A and B, after germination in the intestines. The introduction of the toxins cause diarrhea, which perpetuates the cycle of transmission as spores are introduced back into the environmental surroundings (Crawford, Huesgen and Danziger 933). At least 75% of “diarrhea-associated enteric infections are acquired during a hospital stay” (Miller, Walton, and Tordecilla). The frequency of transmission dictates that the medical professional become aware of those who are at risk of developing this infection. Patel noted that the following risk factors increase the incidence of infection in patients:
1. Antibiotic Therapy
More than 90% of health care associated C. difficile infections are seen during antibiotic exposure. Except for amino glycosides, most antibiotics have been associated with CDAD. The patients who are found to be at a greater risk are the ones who have drug therapies over a long period.
2. Age greater than 65 years
Older people have a high infection rate. They tend to have more health problems than younger people.
3. Severe underlying illness
Patients whose immune systems have been weakened are at greater risk of having recurrent infections
4. Longer hospital stays or lives in a nursing home or long term care facility
5. Nasogastric intubation

6.Patients who have abdominal surgeries

7. Chronic colon disease such as inflammatory bowel disease or colorectal cancer (Patel 102) Patients at risk for C.difficile, who present with multiple episodes of foul-smelling, watery stools, lower abdominal pain, weakness and nausea for longer than 48 hours should raise the healthcare professionals suspicions of a C.difficile infection (Headley 460-461). Once a stool specimen is obtained, enzyme-linked immunosorbent assay (ELISA) can confirm the presence of A and B toxins in a matter of 2-6 hours (Keske and Letizia 331). Due to ease of the transmission of C. difficile spores, it has been suggested that beginning contact isolation precautions for symptomatic patients before the results confirming diagnosis are received, in order to safeguard the heath of others with in the hospital setting. Contact precautions include: the patients being placed in private rooms, performing proper hand hygiene with antimicrobial soap and water, using friction for 15 seconds, and using gloves and gowns during patient care (Keske and Letizia 332). “One should also ensure adequate cleaning and disinfection of environmental surfaces and reusable devices. The uses of both buffered and buffered phosphate hypochlite solutions (bleach) have been shown to decrease the rate of C. difficile contamination and helps in reducing Clostridium Difficile associated disease (CDAD) rates” (Patel 104). A patient diagnosed with CDAD, must discontinue the use of the prior antibiotics. “Excessive antibiotic use and the lack of available treatment options remain major challenges in the prevention and treatment of CDAD. Antibiotic use is both a risk factor for CDAD and the mainstay of treatment” (Crawford, Huesgen and Danziger 934). The primary antibiotic treatment is determined by the patient’s white blood cell count (WBC). Metronidazole and Vancomycin are the most common choices (Keske and Letizia 331). Current research has suggested that Fidaxomicin is well tolerated and has been effective in patients who have presented with a recurrent CDAD. Fidaxomicin is still in the clinical trial phase of investigation. However, this narrow spectrum antibiotic may prove to be a novel alternative to those who have not responded well to other antibiotic options (Crawford, Huesgen, Danziger 941). In the United States, over 3 million Clostridium difficile infections are reported in our hospitals annually (Patel 102).
As the incidence of infection has increased in the recent years, the cost of diagnosis and treatment annually has surpassed 1 billion dollars (Keske Letizia 329). These statistics provide evidence that the healthcare professional must be knowledgeable of Clostridium difficile, it’s mode of transmission, signs and symptoms of infection, and precautionary measures used to inhibit the spread of this contagion. Diligence within the healthcare community is required for the protection of those at risk for this
disease.

Works Cited
Crawford, Tonya, Emily Huesgen, and Larry Danziger. "Fidaxomicin: A Novel Macrocyclic Antibiotic For The Treatment Of Clostridium Difficile Infection." American Journal Of Health-System Pharmacy 69.11 (2012): 933-943. CINAHL Plus with Full Text. Web. 7 June 2013.
Grossman, S, and D Mager. "Clostridium Difficile: Implications For Nursing." MEDSURG Nursing 19.3 (2010): 155-158. CINAHL Plus with Full Text. Web. 7 June 2013.
Headley, Carol Motes. "Deadly Diarrhea: Clostridium Difficile Infection." Nephrology Nursing Journal 39.6 (2012): 459-468. CINAHL Plus with Full Text. Web. 7 June 2013.
Keske, LA, and M Letiz. "Clostridium Difficile Infection: Essential Information For Nurses." MEDSURG Nursing 19.6 (2010): 329-333. CINAHL Plus with Full Text. Web. 8 June 2013.
Miller, Joanne M., Jane C. Walton, and Lydia L. Tordecilla. "Recognizing and Managing Clostridium Difficile-Associated Diarrhea." Medsurg Nursing 7.6 (1998): 348,9, 352-6. ProQuest. Web. 7 June 2013.
Patel, NA. "Clostridium Difficile." Journal Of Continuing Education Topics & Issues 12.3 (2010): 102-105. CINAHL Plus with Full Text. Web. 7 June 2013.