Tawna
Bruun
Literature
Review
Nurs
3600
Article
#1: Prevention and Control of
Clostridium Difficile Infection
Clostridium difficile (C.
diff) is an anaerobic Gram-Positive bacillus. Infection with C. diff usually
happens when the normal flora in the colon is altered because of broad-spectrum
antibiotic use. Symptoms of C. diff
range from mild diarrhea to profuse, watery diarrhea. Instances of large
areas of intestinal epithelium becoming necrosed with ulceration and
life-threatening perforation have occurred.
Transmission of C. diff is
by the fecal-oral route. Transmission can take place in the hospital from the
workers and environmental reservoirs (urinals, bedpans). Spores can live month
or years if not properly destroyed by detergent. Treatment of C. diff can be
done by IV vancomycin or oral metronidazole. Infection prevention and control
can be accomplished through meticulous hand hygiene, isolating the patient, and
environmental cleaning. Hand hygiene (using soap, water and friction and
avoiding alcohol products as they are not effective and do not kill the spores)
and Personal Protective clothing (such as gown, gloves, and shoe covers) can
help to prevent and control the spread of the disease.
Reference
Gould,
D. (2010). Prevention and control of clostridium difficile infection. Nursing Older People, 22(3), 29-37. Retrieved from
http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=4&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=
Article #2: Clostridium Difficile Infection: Risk
factors, diagnosis and control
Clostridium difficile (C.
diff) is one of the most common causes of nosocomial diarrhea in humans.
Morbidity and mortality rates for C. diff have increased in many developed countries
and is estimated to be responsible for about 3 million cases of diarrhea and
colitis each year. C. diff spores pass through the gastric acid in the stomach
and germinate in the small intestine.. C. diff may be accompanied by toxic mega
colon, electrolyte imbalance and occasional bowel perforation. There are
several risk factors associated with C. diff. Age, immunoglobulin level,
antibiotic treatment, surgical manipulation, and antacid and other treatment
regimes. C. Diff is transmitted by commonly
touched surfaces in hospitals such as bed rails, telephones, call
buttons, door knobs, toilet seats and bedside tables of rooms in which the
patient has C. diff. Treatment and control include metronidazole and
vancomycin, and avoiding unnecessary proton pump inhibitors. Health care workers
must wear gloves, appropriate chemicals need to be used to clean and
disinfect. Disinfection with 10% bleach
and chlorine-based compounds are shown to inactivate C. diff spores.
Reference
Koleci,
X., & Janvilisri, T. (2012). Clostridium difficile infection: Risk factors,
diagnosis and control. Albanian Journal
of Agricultural Sciences, 11(1),
21-28. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=8&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=
Article
#3: Clostridium difficile: Implications
for nursing
Clostridium
difficile is a health care challenge due to the many complications it can cause
(hypovolemia, sepsis, pain, peritonitis). C. difficile colonizes in
approximately 40% of hospitalized patients due to the spores frequently present
in the environment on the floors, side rails, bathroom and health care worker’s
hands. Signs and symptoms of C. difficile include abdominal fullness, abdominal
discomfort, malodorous frequent loose stool, elevated white blood count,
elevated temperature, and signs of dehydration. Nursing management includes
discontinuing the prescribed antibiotic, administering a different antibiotic
to treat the infection, assessment of temperature, WBC count, skin care,
assistance with bowel elimination. Also important is the use of contact
precautions, keeping surfaces disinfected with hypochlorite-based cleanser or
household bleach diluted with water (1:10)/. It is important to teach patients
and their families to wash their hands with soap and water and not use alcohol
based cleansers as they are not effective.
Reference
Grossman,
S., & Mager, D. (2010). Clostridium difficile: Implications for nursing. MEDSURG Nursing, 19(3), 155-158. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=14&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=
Article #4: Hospital infection control strategies for
vancomycin-resistant Enterococcus, methicillin-resistant Staphylococcus aureus
and Clostridium difficile
Four key hospital
interventions are the cornerstone for infection control of Clostridium
difficile among other diseases. These cornerstones are hand hygiene,
environmental cleaning, barrier precautions and screening. Patients who have an
infections serve as reservoirs for microorganisms. Risk factors for
colonization include age, severity of illness and the use of antibiotics.
Although alcohol based cleansers are an important part of hand hygiene they are
not effective in killing C. difficile, only the use of soap and water is.
Keeping a clean environment and using disinfectant solutions known to kill the
virus. Barrier precautions to use include gloves and gown and placing the
patient in contact precaution and a private room. Screening ill patients who
show symptoms of C. diff and identifying patients who are ill in a timely
manner so treatment can begin is imperative to treating and reducing the spread
of the disease.
Reference
Johnston,
B. L., & Bryce, E. (2009). Hospital infection control strategies for
vancomycin-resistant enterococcus, methicillin-resistant staphylococcus aureus
and clostridium difficile. Canadian
Medical Association Journal, 180(6),
627-631. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=23&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=
Article
#5: Clostridium difficile- Associated
Disease Diagnosis, Prevention, Treatment, and Nursing care
Clostridium
difficile-associated disease (CDAD) includes diarrhea, pseudomembranous
colitis, toxic megacolon, perforation of the colon, and in some cases, sepsis.
The use of high-risk antibiotics, reduction in housekeeping staff, increased
nursing workloads, antiquated facilities and general changes in hospital
populations (increased number of immunocompromised, debilitated, and elderly
patients) and contributing factors. C. diff spores are resistant to many types
of disinfectants, heat and dryness and may remain on surfaces for months.
Transmission is via the fecal-oral route. Healthy people are able to keep C.
diff at bay due to the healthy flora in the gut. The use of antibiotics and
medications and decrease stomach acidity, such as proton pump inhibitors cause
the bacteria to proliferate. To prevent the spread of C. diff hands must be
washed with an antimicrobial soap for at least 15 seconds. Hands should be
washed before and after contact with a patient and after glove removal.
Cleaning with 1:10 bleach solution is recommended. High touch surfaces such as
doorknobs, light switches, call lights, television remote control, soap
dispensers, faucets, bed rails and telephones need frequent cleaning. Nursing
care includes preventing dehydration, promoting comfort, and maintaining skin
integrity.
Reference
Pelleschi,
M. E. (2008). Clostridium difficile- associated disease diagnosis, prevention,
treatment, and nursing care. Critical
Care Nurse, 28(1), 27-36.
Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=25&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9@sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU=
Article
#6: In the Clinic: Clostridium difficile
Infection
Transmission
occurs through the fecal-oral route, usually by person-to-person transmission.
Contaminated fomites and the hands of health care workers are another source of
transmission. The primary means of prevention are to limit the use and type of
antibiotics and to adhere to infection control measures. This includes using
the appropriate environmental cleaning solutions, limiting the use of
antibiotics, and strict hand washing. Conventional hand washing with soap and
water should be adhered to when caring for patients during an outbreak or
suspected outbreak. Wearing gloves and gowns if contact with patient is to
occur is also necessary (the use of gowns has not had any trials however is
recommended because C. diff has been cultured from the uniforms of workers).
Reference
Clostridium
difficile Infection. (2010). Annals of
Internal Medicine, 153(7),
ITC4.1-ITC4.16. Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=28&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9%40sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU%3d#db=aph&AN=54279457
Article #7: Preventing healthcare-associated
infections: risks, healthcare systems and behaviour.
Modern health care generates
a wide range of infection risks for patients through practices that compromise
the patient against infection. To prevent infections from spreading the use of
hand hygiene is important. During the normal work activities of the healthcare
provider, they transfer a patient’s own microorganisms from one body site to
another, they transfer microorganisms from one patient to another patient, they
transfer microorganisms to and from the equipment they are working with.
Portable equipment must be cleaned and disinfected prior to contact with a
patient and their environment.
Reference
Ferguson,
J. K. (2009). Preventing healthcare-associated infection: risks, healthcare systems
and behaviour. Internal Medicine Journal,
39(9), 574-581.
doi:10.1111/j.1445-5994.2009.02004.x Retrieved from http://web.ebscohost.com.libproxy.dixie.edu/ehost/detail?vid=28&hid=13&sid=13c78a82-5606-409e-9615-ec0413be58e9%40sessionmgr14&bdata=JmxvZ2luLmFzcCZzaXRlPWVob3N0LWxpdmU%3d#db=aph&AN=44218307
Article #8: Role of hand hygiene in
healthcare-associated infection prevention
Healthcare
workers’ hands are the most common vehicle for the transmission of
healthcare-associated pathogens from patient to patient. Optimal hand hygiene
is considered the cornerstone of healthcare-associated infection prevention.
Following the widespread use of alcohol-based hand rubs concern has been raised
about their lack of efficacy against spore forming pathogens. Friction while
washing hands with soap and water may help to physically remove spores from the
surface of contaminated hands. The use of alcohol based hand rubs has been
blamed for the increase in C. diff associated disease rates although there has
not been a study to prove this to date of this article. The improvement of
healthcare workers compliance to hand hygiene will decrease the spread of
infection within the hospital setting.
Reference
Allegranzi,
B., & Pittet, D. (2009). Role of hand hygiene in healthcare-associated
infection prevention. Journal of Hospital
Infection, 73, 305-315. doi:
10.1016/j.jhin.2009.04.019
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