Checklist for Management of a C

December 17, 2008

Checklist for Management of a C.difficile Associated Diarrhea (CDAD) Event

PREAMBLE:

CDAD is the most frequent cause of healthcare acquired infectious diarrhea in industrialized countries, with a spectrum of clinical manifestations from asymptomatic colonization to severe diarrhea, pseudomembranous colitis (PMC), toxic megacolon and death. Recent reports have highlighted an increase in the incidence, severity and risk of relapse of CDAD. This document provides a quick checklist to ensure that all aspects of the management of an individual case of CDAD or a cluster event are addressed consistently. A TEAM APPROACH IS KEY TO SUCCESS.

ENGINEERING CONTROLS

BEDPAN DISINFECTORS AND/OR WASTE MACERATORS
RESPONSIBLE / DATE COMPLETED
Full correct cycle for bedpan disinfectors for all items – the cycle must not be stopped prematurely nor a rinse/hold cycle used
Correct enzymatic detergent is used and dispenser kept filled
Only one item at a time placed in the bedpan decontaminator.
Clear instructions posted for both disinfectors and macerators
Audits of practice for waste disposal to ensure that proper technique is employed
HOPPERS
RESPONSIBLE / DATE COMPLETED
If hoppers must be used, a splash-guard is provided
Spray nozzles in patient washrooms or hoppers are not used
COMMODES/TOILETS
RESPONSIBLE / DATE COMPLETED
Adequate supply of commodes (and bedpans)
Commodes have intact surfaces (cracked items cannot be properly cleaned and must be removed).
Commodes dedicated as single patient use and/or cleaned thoroughly after use
System to ensure that:
commodes are sent to the dirty utility room for cleaning and/or
that clean commodes can be distinguished from dirty ones
Portable toilet seats or raisers cleaned immediately after patient use by nursing staff
ISOLATION ROOMS
RESPONSIBLE / DATE COMPLETED
Cohorting during an outbreak in consultation with infection control staff
Consultation re closing ward occurs if outbreak significant
CLEANING & DISINFECTION
RESPONSIBLE / DATE COMPLETED
Hydrogen peroxide (e.g., Virox) throughout the involved units for environmental cleaning.
Cleaning technique reviewed with housekeeping and with nursing staff
Surfaces are free of clutter.
Over bed tables thoroughly cleaned immediately after they have been used for direct patient care
A special clean once the patient is removed from isolation or discharged. (The patient may still be in the room.)
LABORATORY
RESPONSIBLE / DATE COMPLETED
Consultation with a Medical Microbiologist if stool culture or molecular characterization of isolates is being considered.
ADMINISTRATIVE CONTROLS
RESPONSIBLE / DATE COMPLETED
Gastrointestinal algorithm routinely used on inpatients as well as the Emergency and outpatient areas.
Nurse initiated orders for timely specimen collection to include stools for CD as well as wbc, creatinine to assess severity of disease
Pharmacy review of vancomycin and metronidazole use to ensure patients receive optimal therapy
Linen and waste Management protocols and procedures reviewed
Use of soap and water for hand hygiene if sinks readily accessible.
If access to sinks is limited, alcohol hand rub use is still encouraged.
Patient isolation discontinued only after 48 hours of no diarrhea. A terminal isolation clean is then required.
In-services conducted by Infection Control
Infection Control Committee regularly informed of progress
Reports to the local unit managers/medical directors, Medical Advisory Board, and senior management
Process for physician review of all CDAD
Regular reviews of housekeeping practices,
Audits of hand hygiene compliance
Reviews to ensure GI algorithms used.
Surveillance of cases performed using the CNISP/PICNet protocols and definitions.
PERSONAL PROTECTIVE EQUIPMENT
RESPONSIBLE / DATE COMPLETED
Contact Precautions are used and appropriate personal protective equipment as per the Infection Control Manual