Clostridium difficile is a gram positive, spore forming anaerobic bacillus, which may or may not carry the genes for toxin A-B production. These two types of protein exotoxins produced by the Clostridium difficile bacillus, toxin A and toxin B, can have an infectious form and a non-active, non-infectious form. The disease spreads throughThe spores can survive for a longer period of time in the environment and are not infectious unless and until they are ingested or are transformed into an infectious state.
The infectious form can survive for a short duration of time in the environment. Together, the two toxins cause a large number of inflammatory pacifiers to descend on the colon, triggering more colitis and colonic ulcerations. Purulent debris then results, contributing to the development of a pseudo membrane. With the activation of the inflammatory response, the released pacifiers cause fluid excretion and increased permeability at the mucosal membrane and make the patient susceptible to diarrhea as well as drastic electrolyte and fluid shifts.
Symptoms caused by infection with Clostridium difficile range from mild diarrhea to profuse, watery diarrhea accompanied by severe inflammation of the intestine. The patient may complain of foul smelling diarrhea. Symptoms may also include lower abdominal pain and systemic symptoms such as fever, anorexia and nausea; malaise may be seen. Frank bleeding is rare, although fecal occult blood and leukocytes are frequently detected. Gross bloody stools are uncommon but present with fecal occult blood.
People with a more severe Clostridium difficile infection will experience this symptom of having blood in their stools. They tend to have a fever, poor skin turgor, dry mucous membranes secondary to dehydration, and nausea. Clostridium difficile associated disease ranges from a mild to severe condition. In sever cases, large areas of the intestinal epithelium go through necrosis with ulceration, leading to potentially life-threatening perforation and peritonitis. Clostridium difficile associated disease will resolve when the patient discontinues taking the antibiotics to which they ave been previously exposed. Administration of a different antibiotic is used to treat the infection. The infection can usually be treated with an appropriate course of about 10 days of antibiotics including metronidazole or vancomycin administered orally. On occasion intravenous vancomycin may be necessary. The nurse should ensure patients are not only taking the newly prescribed antibiotic, but also responding to the treatment by showing a decrease in symptoms. Symptoms can recur despite antibiotic therapy, close monitoring is essential.
In order to avoid risk of further complications, nursing interventions would include careful assessment of white blood cell count, temperature, and hydration status; meticulous skin care and assistance with bowel elimination given the loose frequent stools; and management of abdominal discomfort. Clostridium difficile is a particularly difficult infection to control. Because Clostridium difficile spores can live on dry surfaces for long periods of time, prevention must include the importance of cleaning surfaces and washing hands appropriately.
All health workers and visitors who have direct contact with patients or residents or their immediate environment must wash their hands thoroughly using soap and water. Alcohol products are not effective in the control of Clostridium difficile because they do not destroy the spores. Soiled linens and personal articles should not come into direct contact with hands or surfaces. Disposable gloves and aprons should be worn for all contact with patients or residents and their immediate environment, especially when dealing with bedpans, urinals, and environmental cleaning.
All laundry should be labeled according to hospital procedure to avoid hand sorting and contamination of other laundry items. All clinical waste should be labeled for incineration. The patients and families should be taught how to prevent spread of the disease by giving them a list of signs and symptoms to be reported immediately, such as increased abdominal discomfort, cramping, mild-to-moderate non-bloody diarrhea with mild disease; or profuse diarrhea, abdominal pain, nausea, and fever with more severe disease.
Teaching about antibiotic use is critical to ensure patients take their full dose for the prescribed number of days to avoid recurrence of disease and development of possible resistant bacterial strains. I myself have yet to meet anybody with Clostridium difficile, but have heard stories about it becoming an ongoing problem in many nursing homes and hospitals. It calls for strict precautions to makes sure you don’t get the disease; and if contracted is very hard to manage.
* http://www. cdc. gov/hai/organisms/cdiff/cdiff_faqs_hcp. html * http://www. cehs. siu. edu/fix/medmicro/clost. htm * Gould, D. (2010). Prevention and control of Clostridium difficile infection. Nursing Older People, 22(3), 29-37. * http://www. clevelandclinicmeded. com/medicalpubs/diseasemanagement/gastroenterology/antibiotic-associated-diarrhea/ * http://www. freepatentsonline. com/article/Journal-Continuing-Education-Topics-Issues/241102742. html