The journal that I chose to research and look up involves a Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients. I found this journal very interesting as I work on a Medical/Surgical floor. In my past two years of working, it seems as if more of the surgical patient’s ended up with a c-diff infection versus the medical patient’s. In this article it talks about how some hospitals over treat their patient’s with antibiotics to prevent infection however research investigates if the prophylaxis treatment is really necessary or not. It also mentioned antibiotics that were not really assisting in the treatment of the clostridium difficle infection as well. fishbone c-diff Journal Club Critique Form nichole
Turner, M. C., Behrens, S. L., Webster, W., Huslage, K., Smith, B. A., Wrenn, R., Woody, R., & Mantyh, C. R. (2019). Multidisciplinary Approach to Clostridium difficile Infection in Adult Surgical Patients. Journal of the American College of Surgeons, 228(4), 570–580. https://doi-org.ezproxy.fhsu.edu/10.1016/j.jamcollsurg.2018.12.045
It was reported that in the last three decades, the worldwide increase in clostridium difficile incidence has been common among surgical patients becoming a global health challenge. It is recommended that hand-washing and the use of contact precautions should be used by healthcare workers in contact with any patient with known or suspected clostridium difficile infection (CDI). It also recommended that the disinfection of the environment and patient equipment should be done by healthcare workers. “In 2017, a qualitative systematic review including 46 studies investigated the impact of specific interventions on CDI rates in acute-care hospitals. The most effective interventions, resulting in a 45% to 85% reduction in CDI, included daily to twice daily disinfection of high-touch surfaces (including bed rails) and terminal cleaning of patient rooms with chlorine-based products” (2019 Update of the WSES Guidelines for Management of Clostridioides (Clostridium) Difficile Infection in Surgical Patients, 2019).
References
2019 update of the WSES guidelines for management of clostridioides (clostridium) difficile infection in surgical patients. (2019, February 28). Retrieved July 6, 2020, from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6394026/
You bring up a good point on the twice daily disinfecting. At my old job we used to do a bleach wipe on each shift and wipe down the surfaces in each room to help prevent CDI infections between rooms and patient’s. I think that it helped a lot and I noticed that our rates decreased. I really enjoyed your article that you found. Have you had a lot of experience with CDI’s where you work?
I have had some patients with CDI at my workplace. We wipe all equipments and touch surfaces with Sani wipes and Sani bleach wipes. Also, any healthcare staff that enters an isolation room with CDI patients must always perform proper hand-washing.
C-Diff had definitely made a huge come back over the past several years. What a great topic to learn more about!
This particular article from the Mayo Clinic is showing significantly increasing numbers in people that traditionally not considered to be at high risk, such as young healthy individuals who haven’t used antibiotics and who haven’t been in a health care facility, which was the “normal” in the past for being at risk for c-diff. C-diff infections have become more frequent, more severe, and more difficult to treat, which is very scary!
C.Difficile Infection Care. mayoclinic.org/diseases
I agree! I felt like working on a post-surgical unit we saw more and more CDI’s than we used to. I never understood why however after researching the causes of CDI’s it makes complete sense. We have had a few patient’s who required a fecal transplant in order to get rid of the infection. It’s crazy how someone else’s stool can create your normal bacteria and kill the infection. Look at the article below. It’s really interesting.
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5666691/
There is definitely a correlation between prophylactic antibiotic use and C-diff. It is something that must be taken seriously as treating hospital acquired C-Diff is extremely expensive and can lead to sepsis and/or death. I think that more research needs to be done on exactly how helpful or not helpful that prophylactic antibiotic use is in patients.
I agree as well. I mean I totally get the concept of ensuring there is no post-op infection however I think that sometimes it causes over kill. I think that all too much patient’s are treated with antibiotics to ensure that there is no infection however I wonder how many people would even have an infection if aseptic technique was truly used. What are your thoughts on that?
Having worked in long term care, C-Diff was something that we faced fairly frequently. It is interesting to look at the correlation between surgery and c-diff. The article that I looked at stated that even one dose of prophylactic antibiotics placed a patient at risk for c-diff. Which then becomes the greater evil? Potential for infection of c-diff itself?
Great topic!
Sartelli, M., Di Bella, S., McFarland, L.V. et al. 2019 update of the WSES guidelines for management of Clostridioides (Clostridium) difficile infection in surgical patients. World J Emerg Surg 14, 8 (2019). https://doi.org/10.1186/s13017-019-0228-3
I feel like CDI’s in a nursing home is a nightmare. I think about when I worked as a LPN in a nursing home, we had a patient who was on contact for it. Next thing you knew his neighbor had it and it just went down the hall. These people ate together, played games together and sat next to each other. Now, we kept the person who was infected completely isolated however somehow the bacteria was not contained? Any guesses on how the bacteria was spread?
I found this article interesting about the overuse of antibiotics in surgical patients leading to C. diff. I cannot say that I have witnessed this for myself as I have never worked on a Med/Surg floor other than to occasionally float to one, but as a PACU nurse I would frequently help on the Pre-op side and I remember always hanging IV antibiotics before surgeries. I could completely understand how that could lead to increased cases of C. diff. I know they are wanting to prevent a surgical infection but I wonder if an antibiotic solution could be used to irrigate the incision in the OR rather than IV antibiotics. Just a thought.
References
Overuse of antibiotics a major risk factor for C. diff in surgical patients. (2017). Healthcare Purchasing News, 41(10), 16.
That was my thoughts exactly why not treat the affected site with antibiotics instead of treating the whole body. Almost like doing a wound scrub with antibiotics. I feel like the wound itself would benefit from it tremendously while lowering the antibiotic exposure to the patient. Great thought and feedback!