1. A New Guide
C Difficile
Medical Surgical Nursing II

2. CDI’s Development
• C difficile attaches to receptors in the gut
epithelial cell
• Pivotal is exposure to antibiotics, which
destroys the normal gut microbiota and allows
intestinal organisms that are not killed by the
antibiotic to proliferate

3. CDI’s Development
• C difficile attaches produces toxins, resulting
in pseudomembranous colitis and, in some
cases, toxic megacolon and death
• Normal intestinal flora are able to suppress C
difficile and toxin production, preventing the
diarrhea and inflammation characteristic

4. CDI Risk Factors
• Main risk factors for CDI:
– Exposure to antibiotics
– Hospitalization
– Advanced age

5. CDI vs. Antibiotics
• Antibiotics:
– Most antibiotic classes have been implicated in CDI,
but certain antibiotic classes, such as cephalosporins,
clindamycin, and fluoroquinolones, are more likely to
facilitate development of disease
• antibiotics to disrupt normal lower intestinal microbiota
– Fluoroquinolones are hypervirulent strains known as
restriction endonuclease analysis type BI
• Virulence is r/t increased production of toxin A; B & Binary
• Synergistic with toxins A and B.

6. CDI Diagnosing
• CDI is a toxin-mediated disease, which is the
basis testing
– enzyme immunoassay (EIA) for toxins A and B
– toxigenic stool culture
– cell cytotoxicity
– glutamate dehydrogenase testing
– polymerase chain reaction (PCR),

7. TESTING INS & OUTS
• EIA
– relatively inexpensive,
• easy to perform,
– rapid turnaround time
– poor sensitivity, can result in repeat testing and overtreatment.
• Toxigenic stool culture, cell cytotoxicity, and glutamate dehydrogenase
testing
– Expensive
– slower,
– complicated to perform
• PCR
– used either alone or in combination with EIA
• Understand the limitations of the test & how results might change
with a different test.
• Testing only symptomatic patients
– Pt. who are tested must be having diarrhea

8. CDI’s Surveillance &Tracking
• Surveillance
– guide defines surveillance
as regarding a health-
related event to reduce
morbidity and mortality
and to improve health
– use of a case definition for
CDI,
– identification of the
patient population at risk,
– calculation of CDI rates,
– use of control charts
• Tracking
– CMS Inpatient PPS
required
– Reporting of laboratory-
identified CDIs through
National Health Safety
Network (NHSN)

9. Transmission of C difficile
• Ingesting spores found in the environment
that were shed by another patient
• Beds
• Toilets
– flush mechanism
– the sink faucet
– the door handle
• Everyday items

10. CDI Cross-Contamination
• Sharing of electronic thermometers
• Oral care or oral suctioning when hands or items
are contaminated;
• Administration of tube feedings or medication;
• Emergency procedures, such as intubation;
• Sharing of patient care items without appropriate
disinfection;
• Use of contaminated mobile, cellular, or
conventional telephones or pagers during patient
care

11. CDI Prevention
• Contact isolation
• Environmental cleaning
• Hand hygiene
• ABHR - alcohol-based hand rubs
• Best way – Gloving
– removed properly to avoid contaminating
• During outbreaks hand washing rather than
hand rubs

12. Thanks…..