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CLOSTRIDIUM DIFFICILE ...infections (CDIs) aren't
new. Historically, CDIs were diagnosed in older adults who were taking
antibiotics, had gastrointestinal surgery or manipulation, were
hospitalized for long periods, had a serious underlying illness, or were
immunocompromised.1
What is new, however, is a recent study that
shows the rate of hospital-acquired CDI in children almost doubled (from
7.24% to 12.80%) from 1997 through 2006.2 But in contrast to trends in adults, the researchers found no increasing trend in the severity of CDI in children.3
Other studies have identified a decrease in nosocomial
CDIs and an increase in community-acquired CDIs in adults. More adult
patients with CDIs hadn't previously received prescribed antibiotics,
suggesting that C. difficile can now be found outside of the hospital setting.2–5
Take a closer look
C. difficile is a Gram-positive anaerobic
spore-forming, toxin-producing bacillus that commonly causes
antibiotic-associated diarrhea. The major reservoirs are infected
patients, both symptomatic and asymptomatic, and items or surfaces
contaminated with feces. C. difficile is often
transferred to patients via the hands of healthcare personnel who have
direct contact with infected patients or who have touched a contaminated
surface or item.1
Signs and symptoms of CDI include watery diarrhea, fever, anorexia,
nausea, and abdominal pain. Untreated, CDIs may lead to pseudomembranous
colitis, toxic megacolon, colonic perforation, sepsis, and, rarely,
death.1
A CDI is diagnosed through history and physical
assessment, stool cultures, and polymerase chain reaction (PCR) assays.
Unfortunately, stool culture results may not be available for 48 to 96
hours. PCR assays can be run with a high degree of sensitivity within 1
to 2 hours. If stool specimens won't be processed or picked up by the
lab within 2 hours, they must be refrigerated because the toxins rapidly
deteriorate at room temperature.1
According to the CDC, 20% of CDIs resolve after
discontinuation of the antibiotic that inadvertently created the
bacterial imbalance. For the remaining 80%, antibiotic therapy is
necessary. Children with moderate-to-severe illness or persistent
diarrhea after the inducing antibiotics have been stopped should receive
antimicrobial treatment.7 Oral vancomycin and metronidazole are most commonly used.8
Unique risk for children
The increasing trend of CDIs in young children may be the result of a new hypervirulent strain of C. difficile
that is resistant to quinolones. Hospitalized children with medical
conditions such as inflammatory bowel disease and immunosuppression or
conditions that require antibiotics are at a higher risk for CDI.3,6
Young children are also at an increased risk of
contracting and spreading CDIs due to oral exploration of their
environment, hand-to-mouth behaviors, limited experience with hand
washing, and poor elimination hygiene. Diaper-changing stations may be
another source of infection, especially if protective coverings aren't
available and surfaces aren't sanitized after each use. Childcare
centers are another reservoir for community-acquired CDIs. Toys,
toileting, and changing facilities as well as caregivers' hands may all
contribute to inadvertent CDI transmission.
Reduce the risk
Some steps you can take to lower the risk of spreading CDIs in your facility include the following.
* Move patients who need contact precautions into a
single-patient room if possible. If not, consult with infection control
personnel to assess the risks associated with having another patient in
the room. Separating beds by 3 feet or more can help reduce sharing of
items.9
* Wear a gown and gloves for all interactions that may
involve contact with the patient or possible contaminated areas in the
room. Put them on when entering the patient's room and discard them
before leaving.7
* Follow hand hygiene protocol before and after patient care and after removing gloves. Alcohol rubs aren't effective with C. difficile because they're not sporicidal. Use soap and water and vigorously scrub to clean hands.7
* Clean and disinfect nondisposable equipment with sodium hypochlorite diluted 1:10 with water.7 Use equipment dedicated to the patient whenever possible.
* Make sure toys provided for pediatric patients aren't plush or porous.
* Visit www.cdc.gov/hicpac/pdf/guidelines/eic_in_HCF_03.pdf for specific health facility cleaning guidelines.
Patient education
Educate patients and caregivers on the importance of
frequent and proper hand hygiene. Teach patients and caregivers that
soap, water, and vigorous scrubbing for at least 15 seconds is the best
method for getting rid of bacteria on hands.1
Emphasize the importance of perineal care after
toileting, incontinence, or diaper changing. Tell parents to wash toys
and air dry them daily with sodium hypochlorite (household bleach)
diluted 1:10 with water.7
Advise patients and parents of children who've been
diagnosed with a CDI to take antibiotics as prescribed and to avoid
antidiarrheal medications because they may prolong a CDI. Supportive
care includes maintenance of hydration and nutritional status.7 Remind them to contact their healthcare provider if the diarrhea persists or returns.
The recent increase in CDIs in children emphasizes the
need for additional education in proper hygiene for these younger
patients. Taking extra steps to prevent CDIs in your facility can help
avoid complications.
REFERENCES
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© 2011 Lippincott Williams & Wilkins, Inc.
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