Managing Clostridium Difficile

Patients with clostridium difficile are at increased risk of mortality and morbidity. Indirect transmission through the interaction with a healthcare provider is thought to be one of the major routes in which this infection is transmitted. Patients who begin exhibiting more than three loose bowel movements within a 24-hour period can potentially have a clostridium difficile infection. Failure to test patients having active diarrhea early during their admission leads to an increased risk of indirect transmission of clostridium difficile spores. To test or not to test is a project to develop an algorithm and evaluate its effectiveness. Data was gathered from selected electronic medical records to compare the average time between the initiation of loose stools and when a stool sample was resulted. Also compared was the average time from the start of loose stools to when a patient was placed into contact precautions. The goal of the project was to develop an algorithm that promoted early recognition and timely treatment for patients at risk for a clostridium difficile infection. The algorithm was designed to be used by nurses working on a local medical-surgical floor. After implementation of the algorithm, data was collected and evaluated for the effectiveness of the algorithm. The project incorporated four objectives; (a) create an algorithm that helps guide nurses to send a stool sample on the third loose bowel movement; (b) implement the algorithm on a medical-surgical unit; (c) evaluate the average time between the initiation of loose stools and obtaining a clostridium difficile stool sample; (d) the findings were disseminated by submitting an abstract to the organizers of the Fifth Annual International Raising Clostridium Difficile Awareness Conference. The retrospective review included analyzing the electronic medical records for the time that the first bowel movement was documented by the nursing staff. The time when the stool sample was received by the laboratory, the time that the clostridium difficile test was resulted, and the time that the patient was placed into contact precautions following a positive clostridium difficile test was also noted. The algorithm was developed through collaboration with the chief of infectious diseases and the infectious disease nurse. Following its development, 28 nurses were educated about the algorithm and how it can be used to identify patients at risk for clostridium difficile. They demonstrated understanding of the education by obtaining an average of 99% on the posttest. The retrospective and prospective studies were performed from May-August 2016 and January-March 15th, 2017 on the charts of patients that had a clostridium difficile stool test. The average time from the initiation of stools to the obtaining of a stool sample was 43.01 hours for the retrospective study and 5.12 hours for the prospective study. A t-test: assuming unequal variances was performed and revealed there was a difference in the retrospective and prospective data obtained for the time required for a patient to have their stool tested following the initiation of stools. An abstract describing the project and the results were sent to the organizers of the 5th International Raising Clostridium Difficile Awareness Conference and the project committee of the 41st Snowbird CME Conference.