Infection (CDI) Prevention
(C. difficile) is a spore-forming, Gram-positive anaerobic bacillus that
produces 2 exotoxins, toxin A and toxin B, which injure the large intestine,
causing diarrhea among infected patients. C. difficile is the most
commonly recognized cause of infectious diarrhea in healthcare settings.
Clostridium difficile infection (CDI) should be considered when a
patient has received antibiotics in the last 12 weeks and has had 3 or
more diarrheal stools in a 24-hour period. C. difficile, in its spore
form, can survive on surfaces in the healthcare environment for up to
transmitted in the healthcare setting on the hands of healthcare workers, for
example by failing to wash hands or change gloves or gowns between patients, or
by touching soiled surfaces of rooms and shared devices and then touching
patients. According to the Association for Professionals in Infection Control
and Epidemiology (APIC) Elimination Guide for Clostridium difficile
(2008), many patient care activities provide an opportunity for the transmission
of C. difficile. Some examples of these activities are: sharing
electronic thermometers used for obtaining rectal temperatures (even though
probes are changed and probe covers are used, handles may be contaminated); poor
hand hygiene practices; ineffective or inconsistent disinfection of patient care
equipment; and ineffective environmental cleaning.
Strategies for Preventing the Spread of CDI
participating in our CDI collaboratives have had success in preventing the
spread of CDI by implementing the following strategies.
Perform hand hygiene.
Wash hands with soap and water upon exiting the room of a patient/resident
Presumptively isolate symptomatic patients pending confirmation of lab test.
Extend contact precautions for 48 hours beyond the duration of diarrhea.
Monitor compliance with gown and glove use and provide feedback to others.
Educate staff as needed when gowns and gloves are not used properly or at the
appropriate time and positively recognize staff for proper use of gowns and
Properly clean and disinfect equipment and patient care environment.
hypochlorite (bleach) solution or sporicidal cleaning agents. Ensure staff is
following the instructions on how to properly use cleaning agent. For
example, some cleaning agents need to remain wet on a surface for
5 minutes in order to have sufficient time to kill the spore.
Clean high-touch surfaces, such as call button, bed rails, TV remote daily.
Terminally clean room when patient is removed from contact precautions,
transferred, or discharged.
Evaluate cleaning, provide feedback, and make improvements as needed.
Educate patients, family members, and visitors on how to prevent CDI.
Emphasize the importance of performing hand hygiene with soap and water and
the proper cleaning of high touch surfaces and the bathroom.
important for facilities to educate clinicians on the type of test used at their
facility and provide instructions for recommended testing practices for the lab
test used. Changes in laboratory tests may impact surveillance data so it
is important to note if testing modality changes during the course of the
Evaluate and optimize test-ordering
practices and diagnostic methods.
Restrict testing to unformed stool only
unless ileus due to C. Difficile is suspected.
Limit testing on patients at risk for CDI
with > 3 unformed stools within 24 hours.
If you have a negative test, repeat
testing during the same episode of diarrhea is of limited value and should be
you have a positive test, repeat testing should not be used to guide duration
of isolation or treatment.
note: Resolution of diarrhea, particularly resolution of
diarrhea at the conclusion of using therapeutic agents to treat C. difficile,
is the indicator of successful treatment. It is also the end of risk for
transmission from that patient to other patients. Patients who have been
successfully treated for C. difficile and who have non-diarrheal bowel
movements may be found to have a positive test but further treatment will not
help them (treatment of an asymptomatic or colonized patient increases their
risk of developing CDI in the future) and placing them on special infection
control precautions will not benefit other patients, staff or the environment.
Orlando Regional CDI Prevention
Collaborative Supporting Documents
Commitment Form: Acute Care and Long-term Acute Care Hospitals
Commitment Form: Nursing Home
Commitment Form: Home Health Agency and Hospice
User Group Data Use Agreement
Metro Orlando Collaborative Timeline
Collaborative Meeting Schedule and Topics
NHSN: Entering CDI LabID
Events and Jointing the User Group (slides
Jacksonville Regional CDI Prevention
Collaborative Supporting Documents
Definition and Prevention Strategies
CDI Data Collection Form SNF-NH
CDI Data Collection Protocol SNF-NH
CDI Laboratory Testing
Jacksonville CDI Nursing Home Pre-assessment
Metro Jacksonville Collaborative Timeline
Antimicrobial Stewardship Resource Tool
CDC Antimicrobial Stewardship Program Gap Analysis Worksheet
CDI Analysis in NHSN
Environmental Cleaning Training Exercise for English Speakers
CDI Environmental Cleaning Training Exercise for non-English Speakers
CDI Healthcare Provider FAQ
CDI Isolation Contact Precaution Policy Template
CDI Lab Testing Protocol Template
CDI Laboratory Test Result Algorithm for Surveillance
CDI Recovering at Home
Comparison Chart for CDI Lab Tests
Precautions Observation Form
C. difficile Infection Surveillance and C. difficile LabID Event
CDI NHSN Data Entry
CDI Prevention Bundles
Understanding CDI Lab Testing
APIC Guide to Elimination of CDI
CDC Vital Signs Stopping C. difficile Infections
Clostridium difficile Infections in Florida Hospitals Inpatients
Evaluating Hygienic Cleaning in Healthcare Settings
Clinical Practice Guidelines for Clostridium difficile Infection in
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