Clostridium Management in LongTerm Care长期护理中的梭状芽孢杆菌管理.ppt

Clostridium Management in Long-Term Care Spring 2011 Joint Provider/Surveyor Training Teri Lee Dyke, RN, MSN, CIC Clostridium difficile Infection (C. diff, CDI, C. difficile CDAD) Two Case Reports *[Case 1] Two Case Reports *[Case 2] Why C. difficile is interesting It is a bacterial infection in which antibiotics cause (or at least contribute to) the disease It is one of the only anaerobic organisms that can be a nosocomial pathogen Its mechanism of pathogenesis is almost completely toxin production; it does not invade the tissues It is the only nosocomial pathogen that forms endospores that are nearly impossible to kill The most effective treatment for the disease may be to expose the patient to more bacteria Outline Clostridium Difficile the disease Epidemiology Infection Prevention/Mitigation Strategies for Management in LTC Resources C. Difficile the disease Microbiology Description Gram positive spore-forming anaerobic bacteria Natural habitat GI tract of mammals Identification Not normally cultured from stool; difficult to grow Clostridium difficile Anaerobic spore-forming bacillus Clostridium difficile-associated disease or diarrhea (CDAD) Pseudomembranous colitis, toxic megacolon, sepsis, and death Fecal-oral transmission through contaminated environment and hands of healthcare personnel Antimicrobial exposure is major risk factor for disease Acquisition and growth of C. difficile Suppression of normal flora of the colon Clindamycin, penicillins, and cephalosporins Modes of Transmission Fecal-oral Food Fomite (contaminated object) Person-to-person Taking care of an ill individual Fomite (contaminated object) Inpatient healthcare setting Previous antibiotic exposure Symptoms of CDAD Watery diarrhea Loss of appetite Fever Nausea Abdominal pain and cramping Colonization vs. Infection Colonization No clinical symptoms More common than disease presence Patient will test positive for Clostridium difficile and/or its toxin Infection Watery diarrhea Abd