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SNF Infection Control Guidelines for C. Difficile Cheat Sheet (DRAFT) by [deleted]

Infection Control Guidelines for C. Difficile

This is a draft cheat sheet. It is a work in progress and is not finished yet.


At least 25 percent of antibiotic prescr­iptions in nursing homes do not meet clinical guidelines for prescr­ibing. This use and overuse of antibi­otics results in side effects and drug-r­esi­stant bacteria. The Commun­ication and Decisi­onm­aking for Four Infections toolkit aims to reduce inappr­opriate prescr­ibing for the four infections for which antibi­otics are most frequently prescribed in nursing homes:
(1) Urinary tract infections (UTIs)
(2) Lower respir­atory tract infections
(3) Skin and soft tissue infections
(4) Gastro­int­estinal infections

When to Perform Toxin Assay on Stool

Resident sympto­matic with diarrhea ( >3 loose/­watery stools a day).
Especially consider in residents who received antibi­otics in previous 60 days and have one or more of the following: fever, elevated WBC, fecal leukoc­ytes, abdominal pain/t­end­erness.
Do not perform toxin assay on formed stool.
Do not culture stool; only perform toxin assay.
After treatment, do not retest for cure (toxin may stay positive even when resident is improved).

When to Treat

Sympto­matic resident with toxin-­pos­itive stool.

How to Isolate Cultur­e-p­ositive Residents

Limit time outside of room for C. difficile positive resident while sympto­matic; limit time especially if resident is unable to contain stool.
Use gloves for contact with resident or resident’s enviro­nment while on therapy.
Perform hand hygiene with soap and water (alcohol does not kill C. difficile spores).
Consider daily use of diluted hypoch­lorites (household bleach diluted 1:10 with water) to disinfect resident’s enviro­nment.

C. difficile bacteria wreak havoc in guts

Pathog­enesis of Clostr­idium difficile

From Coloni­zation to Infection