Clostridium Difficile: A Case Study

Title - Knowledge, attitude and practice of paediatric nurses on infection control INTRODUCTION Infection control is an essential part of nursing care delivery in each setting to reduce risks for morbidity and mortality in patients and care givers at all levels. Basic principles of infection prevention are simple and include personal hygiene and hand washing. More extensive infection risk reduction strategies are necessary for the management of indwelling devices such as enteral feeding systems, central venous catheters, intravenous cannula, devices and facilities for assisted ventilation and for surgical procedures that involve permanently implanted foreign bodies such as total joints and pacemakers. Infection risk reduction in patients across entire care, nurses must be vital role in infection control. It is essential to check the safety of patients as well as healthcare personnel and those who visit the health care environment.

Although Florence Nightingale was one of the first theorist of the nursing profession, her patient environmental relationship is still relevant today. Keeping the patient 's environment free from pathogens is difficult at times, but I, as a nurse, can control the patient 's immediate environment. While working on a surgical unit in a hospital, decreasing exposure to pathogens starts before meeting the patient. By washing my hands or using alcohol based hand wash before entering the patient 's room. Applying gloves while examining patients skin or cleaning an incontinent patient. Providing clean sheets and gowns to decrease the spread of germs on a fresh post operative patient. Positioning a patient for comfort to help decrease their pain. Decreasing the noise level to ensure proper rest. Removing used laundry, drinks or meals and trash items that harbor the growth of bacteria. The particular environmental factors I can control are many. As part of my job, I ensure the safest and cleanest environment possible while caring for my

Clostridium Difficile (C. difficile) is a bacteria-related gastrointestinal infection that is caused (etiology) by the use of antibiotics therapy or exposure to the C. difficile spores (Swartz, 2013). According to published reports compiled by the California Department of Public Health (CDPH), National Safety Network (NHSN), and the Center for Disease Control Prevention (CDC), the rate of CDI have a major financial impact (costs associated with medical management of CDI) on health care institution across the United States. CDI is major concern for hospital administrators and patients at Sharp Grossmont Hospital (SGH) and other in hospitals within the Sharp Healthcare Network (SHN). According to data released by CPDH and the CDC, from January to December 2012 three hospitals within the (SHN) reported 136 new cases of CDI. Statistical data also show that 20,000 to 34,000 patients were admitted or readmitted to the hospitals for recurrent complications related to CDI such as electrolyte imbalance, nutrition deficits, and systemic bacteremia (CDPH, 2013).

Clostridium difficile, formally named Bacillus difficilis, due to how difficult it was to isolate and cultivate was first isolated from newborn infants in 1935. (Hall and O’Toole, 1935). It was not until 1970, that a relationship was formed between C. difficile and humans with colitis (Ehrich et al., 1984). In 1984, was the first time C. difficile was identified in mature horses, located in the Potomac River area, with diarrhea. Cases of C. difficile colitis in horses treated with antimicrobials increased in 1993. Since then, many studies have looked at horses with diarrhea in relations with the presence of C. difficile (Baverud et al., 1997).

Hand hygiene is one of the first skills in standard care of practice that is stressed in nursing school. Since the main source of cross-infection is the transmission of microorganisms from the hands of healthcare workers, this problem can be easily prevented by hand washing. However, despite the cheapness and effectiveness of hand hygiene, fewer than 50% of healthcare workers utilize these methods (Kelcikova, Skodova, & Straka, 2011, p. 152).

This article overall purpose is to inform the importance of knowledge and practice of effective hand hygiene and hand care to prevent or reduce cross-contamination from healthcare personnel to patients (HCP). As the article’s author expressed at the introduction “ Healthcare-acquired infections are a major source of illness and death in hospitalized patients, and approximately 20%-40% of these infections are a result of cross-infection via the hands of healthcare personnel” (Eve Cuny 1)

According to the article The mechanism and efficacy of probiotics in the prevention of Clostridium difficile-associated diarrhea there is a great concern about increasing incidence of C. difficile infection due to use of broad spectrum antibiotics. Clindamycin, third generation of cephalosporins and flouroquinolones are considered high risk antibiotics. It is believed that normal gastrointestinal flora has potential effect in inhibition C.difficile growth and toxin A,B release which offen associated with sever diarrhea resulting in patient’s mortality and other comorbidities. After first episode, there is a high chance for relapses due to reduction serum IgG antibodies to toxin A and colonic IgA secretion cells.

Once the charge nurses have been selected, the next step will be to train these nurses using the methods proposed by the World Health Organization (WHO), which recently developed a concept called “My Five Moment for Hand Hygiene” (World Health Organization, 2012). An instructor’s manual with handouts that focuses on infection prevention information from WHO, and a copy of the hospital policy on hand hygiene will be made available for each training session, staff nurses with receive copies during their training sessions. The nurse educator committee will assign charge nurses from the ICU and medical surgical units to attend one of the training sessions held at the fourth floor auditorium from June 2014 onwards. The nurse educator and the infection control nurse committee will need to ensure that the auditorium is available every Wednesday from 8am to 5pm during the training period.

Each year the number of health care associated infections (HAI) increases and has been estimated to be in the hundreds of millions of people around the world. In the United States this accounts for approximately 1 in 25 patients ("Hand Hygiene Basics," 2014). Health care associated infections are considered to be the most persistant adverse event in health care. Hand washing is considered to be one of the best methods for preventing the spread of infection and that poor hand hygiene places patients at high risk ("The Evidence for Clean," n.d.). Patients receiving care in hospitals, long term care facilities, and nursing homes are especially at high risk for developing infections while being cared for. Most health care associated infections

The responsibility of preventing hospital acquired infections does not solely rest upon the feet of the nursing staff. The effort must be a team effort that includes all of the personnel at a facility.

Objective data are observable and measurable. This information is usually obtained through the senses as sight, smell, hearing and touch, during the physical examination of the patient. During Mary was assessed, this is the objective data: symmetrical abdomen, bowel sounds in all quadrants, tender to palpation in the lower quadrants, guarding, skin is warm and moist and her lips and mucous membranes are dry.

Bacteria and infections surround us on a daily basis and can also contribute to the spread of infection and disease. Infections can be potentially harmful to the human body and therefore need to be “controlled and prevented”. In facilities such as hospitals these germs can spread faster due to the amount of bacteria and sick patients surrounding these facilities. This means the control of these infections are to be a high priority. UKCC 2007-2014

The role of nurses in the prevention of MRSA in the hospitals cannot be overemphasized. The prevalence of MRSA in hospitals calls for awareness and sensitization of all party involved in patient caregiving in the hospital. According to Wilkinson and Treas (2011), nurses take on many roles in the hospital: a caregiver, advocate, communicator, leader, manager counsellor, change agent and an educator. (Wilkinson &Treas. (2011) p.13.) The target of healthy people 2020 is to reduce MRSA and all other hospital acquired infection by 75% in the year 2020. (Healthy people 2020) This cannot be achieved without the maximum support of nurses because nurses have regular one on one contact with patients on daily basis.This paper will take a closer look at the role of a nurse as an educator in the prevention of MRSA in the hospital. One of the nurse’s roles in the prevention of MRSA in hospitals is patient/visitor/staff education.

Thus, for the purpose of this paper, I will be describing a scenario that I witnessed where a Registered Care Aide (RCA) provided care in an inappropriate manner by means of hand hygiene and highlight the importance of infection control as a way to minimize nosocomial infections and contamination of the surrounding