It’s estimated that Clostridium difficile (C. diff) causes about 450,000 infections and 15,000 deaths each year. Recently, on Facebook, AJN’s question of the week asked about isolation precautions for patients with C. diff. Most readers could not provide the correct answer to the multiple choice question.
In this month’s issue, “Six Things You Can Do Today to Prevent Hospital-Onset C. difficile Tomorrow” offers a quick update of the best ways to prevent C. diff infection and transmission in hospitalized patients.
Author and infection prevention nurse Nancy O’Connor explores the finer points of key basics, including the importance of maintaining a high index of suspicion for cases, performing excellent hand hygiene, and cleaning all surfaces in a case patient’s room with a bleach solution. (And did you know that if the patient remains in the same room posttreatment, after symptoms have resolved, the room should be terminally cleaned to avoid reinfection?)
Isolation precautions and C. diff.
So, what about isolation precautions, which need to be started as soon as C. diff is suspected? Most respondents to our Facebook question thought that standard precautions were sufficient until a C. diff diagnosis was confirmed. But if this “rule-out” patient with diarrhea is positive, does s/he begin to shed C. diff only after the infection has been diagnosed? Of course not. A hospital with a policy of isolating only after a confirmed diagnosis exposes not only the patient’s roommates but all patients on that unit to possible infection with this sometimes fatal organism.
Shortsighted hospital policies and priorities?
My greatest concern about the incorrect answers on Facebook was not the answers themselves, but what readers’ comments suggested about hospital policy and nursing priorities.
At hospitals that isolate only after diagnosis, some nurses felt their facilities followed this protocol in order to save money on isolation gear and blocked beds. (A shortsighted policy, as increased transmission and more patients on contact isolation precautions will ultimately cost the hospital even more.)
Other nurses made it clear that even though they knew this was a bad, non-evidence-based policy, they felt they had no choice but to follow it.
Initially, it is often the nursing staff (guided by CDC protocols), not physicians, who are responsible for decisions about the need for isolation precautions. If this is not a clearly written policy in your facility, it needs to be. What is the point of isolation precautions if they are delayed until the “right doctor” (the patient’s attending? Infectious Disease? GI?) comes along to assess the patient and orders precautions?
If your hospital takes the “what we don’t know can’t hurt us” approach to C. diff isolation precautions, please share with those in your chain of command the evidence for rapid isolation (see this month’s article and its references).