clinical-nursing-pediatrics-2018-posters-abstracts

11 / 22

Page 55
allied
academies
Current Pediatric Research| Volume: 22
November 28-29, 2018 | Dubai, UAE
15th World Congress on
Pediatrics, Clinical Pediatrics and Nutrition
28th International Conference on
Nursing Practice
Joint Event
&
Clostridium difficile: Environmental controls and testing methodology redesign to reduce incidence in an
acute care setting
Jacqueline Whitaker
Florida Hospital Tampa, USA
Clostridium difficile was discovered in 1935, but it was
not recognized as a cause of antibiotic associated
diarrhea until 1974 when a “clindamycin-associated colitis”
was identified. Research beginning in 1978 determined
the following: (1) cytotoxin assay as the preferred method
for diagnosis; (2) clindamycin was the common inducing
agent; (3) identified toxin A (“enterotoxin”) and toxin B
(“cytotoxin”); (4) confirmed the age-associated risk; (5)
identified acute and chronic care facilities are high risk; and
(6) established oral vancomycin as the treatment of choice.
During the 21st century a more rapid detection method was
developed, the real-time polymerase chain reaction (PCR) test.
With the advent of the PCR test, the specificity and sensitivity
were maintained, but the turnaround of the diagnostic test
result was measured in hours as compared to days for a cell
cytotoxicity test via tissue culture. Combined with patient
symptoms, providers could confirm presence of the genetic
code for C. difficile toxins from stool samples through use of
the PCR test. This provided clinicians with a rapid, specific and
sensitive diagnostic test to prescribe definitive antimicrobial
treatment versus empiric antimicrobial treatment to patients.
There is no single recommended testing methodology or
algorithm for C. difficile currently. When our hospital converted
to the use the C. difficile PCR test as a single diagnostic tool,
we saw an increase in the number of healthcare associated
test results reported due to the C difficile PCR test. With
the potential for increased utilization of antimicrobials for
colonization versus active disease, some hospitals have chosen
to use a combination of antigen and toxin test methodologies
with the PCR test reserved for discrepant test results.
Our hospital converted to the Cepheid Xpert C. difficile assay
(Sunnyvale, CA) in December 2011 as the primary method for
C. difficile identification. With the increased sensitivity and
specificity of the test results, thehospital reported an increase in
healthcareassociatedtestresultsandutilizationofantimicrobials.
As a result, the infection control program in conjunctionwith the
antimicrobial stewardship leaders developed an algorithm for
testing that included the C. difficile antigen and toxin test (PCR
test for discrepant results only), isolation and cleaning protocol
during admission and at time of discharge. An educational
program for the physicians, nursing and microbiology staff
covered the Bristol stool chart and appropriate stool type for
testing, discontinuation of stool softeners and laxatives for 48
hours, as well as the need for 3 loose, watery stools within a
24-hour period. The environmental cleaning protocol utilized
a sporicidal disinfectant on all lateral surfaces, including the
floors, during admission and at time of discharge. The use of the
UVC machine was included at time of discharge to ensure the
patient room was cleaned and disinfected for the next patient.
The instances where Nursing units have more than one positive
test results, the isolates are sent for DNA typing to determine
if there was cross transmission among the patient population.
There was a seventy five percent (75%) reduction in the
positive C diff test results with the new testing methodology.
Infectious Disease physicians can call the Laboratory for
specific requests not included in the testing algorithm.
A combination of a new testing methodology algorithm,
automated notification of patient discharge, an environmental
control program that includes a sporicidal disinfectant and the
useofUVCat timeofdischargehasallowedouracutecare facility
to maintain this reduction consistently for the last nine months.
e:
Pediatrics and Clinical Pediatrics 2018
& Nursing Practice 2018, Volume 22
DOI: 10.4066/0971-9032-C2-006