Clostridium Difficile Infections in Long-term Acute Care Hospitals.


ClostridiumDifficile Infections in Long-term Acute Care Hospitals.

Clostridium is atoxin-producing bacteria spread among humans through the bowel. Thebacteria forms spores and are classified as anaerobic gram-positivemicroorganisms. The pathogens cause C difficile associated diarrheaor C difficile infections and mucosal inflammation. The growth of thepathogen emanates from several factors such as poor environmentalcleanliness standards, inappropriate use of antibiotics and changesin infection control practices in the hospital. The title Clostridiumdifficile originates from the Greek term ‘Kolster’ that meansspindle. The microorganism was first given the name Bacillusdifficilis in the year 1935 due to the difficulty experienced bymedical researchers in isolating the organism from its anaerobicculture. Later, in 1970’s, scientists revealed that themicroorganism was responsible for producing toxins and renamed it todifficile. The first case of pseudomembranous colitis (PMC) occurredin 1974. The outbreak indicated the relationship between the Cdifficile microorganisms, clindamycin and PMC patients (Leffler &ampLamont 2015).


ClostridiumDifficile contributes to the increased mortality rate in hospitalsand the community. In the case of health centers, the use ofantibiotics is a significant risk factor. Although all antibioticsare associated with the infection, research has revealed a highersusceptibility related to the use of amoxicillin, cephalosporins, andampicillin. Environmental contamination in the hospitals and thecommunity are additional predisposing factors. The severity of thedisease increases with age (Goudarzi et al., 2014).

According toGoudarzi et al. (2014), microorganisms outbreaks are ten times higherin patients aged 65 years and above compared to their youngcounterparts. Although the transmission of infections transpires inhospitals, the occurrence of the disease has increased dramaticallyin community settings. Community-based infections as compared to thehospital-based transmission of the illness occur in young individualswithout explicit exposure to antibiotics or any other known riskfactors. The key models of community-based transmission remainunknown. However, the mortality rates of community-based C difficiledisease are lower compared to nosocomial transmissions due to theyoung age of the patients and the absence of preexisting conditionsof non-hospitalized persons. A majority, 40%, of community-basedpatients requires hospitalization, and the chances of diseasereoccurrence are similar for both hospital and community-basedpopulations (Goudarzi et al., 2014).

Review of the Literature

C difficilesepticity is associated with an austere ailment. The infectionmortality rate is 5%, and the mortality rate ranges from 15-20%. Asevere case of the disease relates to a white cell count greater than15,000 per cubic millimeter. Other identifiers of the illness includehypoalbuminemia as well as acute kidney damage that serve as anindependent indicator of death and urgent colectomy. The key riskfactors include advanced age, severe episodes of C difficileinfections and continuous usage of antibiotics not intended to the Cdifficile microorganisms (Erik et al., 2014).

Enzymeimmunoassay tests conducted on the patient`s stool helps to diagnosethe existence of the microorganisms. Besides, an alternative methodentails the use of DNA-based tests to identify microbial toxin genesin a uniformed stool or through stool anaerobic culture for Cdifficile microorganisms. Hospitals use enzyme immune assays fortesting the presence of the bacteria since it is an easy method. DNAtests results detect toxigenic strains since they provide highersensitivity and specificity compared to immunoassays (Goudarzi etal., 2014).

The absence ofan effective vaccine to the microorganisms has contributed to thecontrol of against C difficile infection by focusing on antibioticstewardship and prevention of spread within healthcare facilities andprobiotics. According to research, the incidence of themicroorganisms on hospitalized patients reduces by minimizing the useof antibiotics. Additional research reveals that hospitals lessen thefrequency of the organisms by 77% through conducting educationalcampaigns and prohibiting the use of ciprofloxacin and ceftriaxone(Forster et al., 2012).

Contributions and Roles the Nurse in Healthcare

Nurses have a significant duty in the provision of health care. Theirtraditional role entails promotion of health services by preventingdiseases and changing the behaviors of individuals concerning theirhealth. The role played by nurses is complex as it ismultidisciplinary. It includes consultation, patient education,illness prevention and follow-up treatment. The nurses have played asignificant contribution towards reducing symptoms of chronicdiseases through improved hospital care effectiveness and increasedpatient’s experiences in e-health care services. Heath promotionprovided by nurses has led to positive health outcomes such asadherence, higher quality of life, increased patient’s knowledge ontheir illnesses as well as self-management (Kemppainen, Tossavainen &amp Turunen, 2012).

Nurses arecritical to the provision of CDI-related information to the patientsas well as the visitors. Besides, they provide information on how touse personal equipment in the right way and the importance of handhygiene. They advise the patients on the need to wear gloves andprotective aprons whenever they provide care to the patients. Nursesalso play the role of surveillance as a strategy to identify anyincidences of Clostridium difficile infections (Mitchell et al.,2014).

A Comparison of Healthcare Policies

The key policieson diagnosis provide that testing for C difficile microorganisms, orits related toxins should be conducted solely on diarrheal (unformed)stool unless there is the suspicion for an ileus formed by themicroorganism. Research has dismissed the clinical usefulness ofusing testing excreta from asymptomatic patients to evaluate for cureexcept in epidemiological studies. Although Stool culture is the mostsensitive test for epidemiological studies, it is disregarded in theclinical environment due to its slow turnaround time. Most clinicalpolicies advocate for toxin setting within the clinical environment.However, the lack of sensitivity serves as a major shortcoming of theapproach. Consequently, clinicians apply a two-step approach thatincludes the identification of glutamate dehydrogenase (GDH) duringthe initial screening processes. Afterward, clinicians should usecell cytotoxicity assay or the toxigenic culture to confirm the GDHpositive specimens only (Goudarzi et al., 2014).

Health carepolicies allow hospitals to conduct Clostridium Difficile infectionsurveillance to evaluate the rates of CDI and estimate the burden ofthe illness within the health care facility. However, hospitals mayuse either traditional disease surveillance reporting orlaboratory-based reporting. Traditionally based monitoring includesthe use of chart reviews to evaluate the date of symptom onset. Theyhelp in determining whether the patients meet the surveillancedefinition for CDI. Laboratory tests serve as the basis foridentifying potential infections. Other hospital policies advocatefor the use of Laboratory-based reporting in case identification. Inthis case, medical personnel desists from using chart reviews basedon the assumption that all positive tests entail patients with CDI.The date of obtaining the stool from the patients serves as the proxyfor the onset of the illness (Erik et al., 2014).

Ethical Issues and Decisions Faced inHealthcare

According to theAmerican Nursing Association on the management of patients with CDIinfections, isolation is one of the best practices upon suspectingthe incidence of the disease. A patient should be isolated in asingle room with unsuited facilities where possible. In cases withoutappropriate unsuited facilities, the hospital should allocate adedicated commode to the patient. Vacated bed spaces require thoroughcleaning before admitting another patient as per the instructions forfinal cleaning in source isolation policy (Forster et al., 2012).

Hospital staffshould maintain high-level hygiene. According to research, staffhands are the key mode of transmission of the microorganisms.Therefore, the team should use soap and water for hygiene rather thanalcohol abs. The patients should be encouraged to wash their hands.In cases where patients are bed bound, the hospital should providewet wipes for hand hygiene as an alternative for water and soap.Protective clothing helps in preventing CDI transmissions in casesinvolving direct contact with the patient. They also thwarttransmission when the medical staffs are cleaning the isolation bay.The workers should clean their hands with soap and water afterremoving protective clothing. Visitors require being advised to washtheir hands and avoid eating or drinking while in the room. Nursesshould provide information on the risk of contracting the illness toguests who disclose their use of antibiotics (Forster et al., 2012).

Global Healthcare Delivery Systems

Modern healthcare delivery systems face fraught challenges in the provision ofsafe medical environments. The global health care environment hassuffered burgeoning performance improvement in infrastructure aimedat providing quality and safe care for patients and their families.Although the frequencies of CDI have increased in severity andfrequency globally, most mild to moderate cases of the illnessrespond to metronidazole or vancomycin. Besides, alternatives forrefractory and recurrent cases of the disease are currentlyavailable. Metronidazole and vancomycin are the primary therapyoptions for CDI illness. Metronidazole is the agent of choice forinitial treatment and first recurrence for the most patientsdiagnosed with mild to moderate CDI (Leffler &amp Lamont, 2015).

Program Level Student Learning Outcomes

The studentoutcomes should entail the acquisition of the knowledge thatClostridium Difficile is a well-known contributor of health carerelated diarrhea. Besides, the incidence of CDI-related illnessesincreases at a ratio of 1:6 as indicated by research conducted onrecent outbreaks. It is imperative to learn that CDI is a leadingfactor to prolonged hospitalization and therefore, a source offinancial burden to the hospital. Such program outcomes are necessaryfor the students to identify the need for efficient nursing practicesas a strategy to eliminate the disturbing CDI trends. Nurses shouldlearn about the symptoms of the illness, and that CDI infectionsoccur during the process of ongoing antibiotic treatment orchemotherapy exposure (Goudarzi et al., 2014).


CDI isubiquitous within the hospital environment. Nurses have a criticalmandate in the prevention against the transmission of the illness.The spores are transmitted from one patient to the other through theimproperly sanitized hands and using the contaminated equipment.Therefore, cleanliness and strict adherence to isolation protocolsare the key foundations for preventing the transmission of thedisease. The ability of the patient to shed off spores after symptomssubside requires nurses to communicate with the institutionalepidemiology staff to determine the appropriate length of patientisolation. Besides, nurses should carefully clean hospital equipmentshared between patients.

They shouldcollaborate with the housekeeping staff in the provision of effectivecleaning to areas of potential contamination. Proper diseasemanagement calls for the education of patients about the bacteriumand the approach to prevent bacterium transmission. Nurses arecritical agents of providing patient education regarding CDI relatedillnesses. Patient’s education should be free of jargon andappropriate to the patients’ health literacy levels. Multipledelivery methods such as teach-back and show back approaches areuseful in demonstrating the understanding of activities such aswashing hands and donning isolation of equipment.


Leffler, D &ampLamont, T.(2015). Clostridiumdifficile infection. TheNew England Journal of Medicine, 372(25),1539-1548 Retrieved from

Mitchell et al(2014). Clostridium difficile infection: nursing considerations.NursingStandard,28(47), 43-48. Retrieved from

Erik et al.,(2014). Strategies to prevent clostridium difficile infections inacute care hospitals: 2014 update. Infectioncontrol and Hospital epidemiology,35(6), 628-645. Retrieved from

Forster, A.,Taljaard, M. Oake, N., Wilson, K.,Roth, V. &amp Walraven, C.(2012). Theeffect of hospital-acquired infection with Clostridium difficile onlength of stay in hospital. CanadianMedical Association Journal,184(1), 37-42. Retrieved from

Kemppainen, V., Tossavainen, K., &ampTurunen, H. (2012).Nurses`roles in health promotion practice: an integrative review. OxfordUniversity Journal of Interhealthcare,1(1), 1-10.