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Better System Performance
Published in Paul Batalden, Tina Foster, Sustainably Improving Health Care, 2022
Mark E. Splaine, Jeremiah R. Brown, Craig N. Melin, Rosalind A. Lasky, Tina Foster, Paul Batalden
Hospital-acquired Clostridium difficile infection remains a significant cause of morbidity and mortality.12,13 There are many patient and system factors that contribute to C. difficile infection. The patient factors include advanced age, exposure to antibiotics, and immunosuppression. The system factors most commonly associated with C. difficile infection are insufficient hand hygiene, insufficient environmental cleanliness, and poor antibiotic stewardship.
Bowel disorders
Published in Henry J. Woodford, Essential Geriatrics, 2022
An underlying condition causing malabsorption is suggested by steatorrhoea (oily stools) and bulky malodorous pale stools.24 An inflammatory colonic condition is suggested by blood or mucous mixed with the diarrhoea. There may be a family history of neoplastic, inflammatory bowel or coeliac disease. Previous surgery can cause diarrhoea. Extensive resections of the absorptive bowel surface can produce fat or carbohydrate malabsorption. Bacterial overgrowth can occur following bypass operations (e.g. bariatric surgical procedures). Chronic diarrhoea can occur after cholecystectomy, e.g. bile acid diarrhoea. There may be a history of pancreatic disease. Occasionally, systemic diseases such as thyrotoxicosis can precipitate diarrhoea. Diabetes can cause autonomic neuropathy and sugar-free sweets often contain the osmotic laxative sorbitol. Diarrhoea is common in alcohol misuse and can occur with excessive caffeine intake. Recent overseas travel could result in an infectious cause. Recent antibiotic therapy is associated with Clostridium difficile. Many medications can potentially cause diarrhoea (seeTable 12.4). Overflow diarrhoea can occur secondary to faecal impaction, which is suggested by diarrhoea following a period of constipation.
Meeting personal needs: elimination
Published in Nicola Neale, Joanne Sale, Developing Practical Nursing Skills, 2022
When someone has diarrhoea that could be infective, cross-infection measures needed are prompt and careful disposal of the faeces, use of non-sterile gloves and aprons, scrupulous hand washing and source isolation (see Chapter 12). When caring for people with diarrhoea caused by Clostridium difficile, alcohol hand rub is ineffective against the spores produced, so wearing non-sterile gloves, with hand washing following glove removal, is essential.
First case of Candida auris infection in Belgium in a surgical patient from Kuwait
Published in Acta Clinica Belgica, 2020
Klaas Dewaele, Johan Frans, Annick Smismans, Erwin Ho, Tim Tollens, Katrien Lagrou
C. auris has an unusual ability for persistence in patients and in the hospital environment, contributing to its capability of causing nosocomial outbreaks. Extensive colonization of the patient’s direct environment (including the mattress, chairs, trollies, radiators, window sills) was documented in several cases [9,11]. A study confirmed its ability to survive on plastic surfaces for over 2 weeks, an uncommon property among clinical yeasts it shares with Candida parapsilosis [31]. In an in vitro study comparing the activity of different antiseptics against Candida species (including C. auris), hydrogen peroxide and sodium hypochlorite were found to be significantly more potent than quaternary ammonium derivatives, acetic acid and ethyl alcohol [32]. In a Spanish outbreak, walls of patient’s rooms were culture-positive even after cleaning with quaternary ammonium based disinfectants [17]. A hospital outbreak in the U.K. was traced back to colonized axillary temperature probes [33]. Clinical data on the differential potencies of disinfectants against C. auris is scarce [34,35]. The CDC currently recommends using a disinfectant effective against Clostridium difficile spores [36]. In our patient, on two occasions, extensive environmental screens of the patient’s room were negative after cleaning with sodium dichloroisocyanurate (NaDCC) 1500 parts-per-million (ppm) solution.
Proteomics and the microbiome: pitfalls and potential
Published in Expert Review of Proteomics, 2019
Huafeng Lin, Qing-Yu He, Lei Shi, Mark Sleeman, Mark S. Baker, Edouard C. Nice
Certain microbial species may render a person more susceptible to infection or disease. To date, research has focused on individual pathogens to establish how microbiota interact with their hosts. For example, it was found that pathogenic Clostridium difficile can put an individual under risk of developing infections after receiving antibiotic treatment [1, 21]. Fortunately, there is enough diversity in the microbiome community to enhance its ability to defend against pathogenic organisms [22]. The bacterial species Helicobacter pylori has a Janus ‘duality’ function. On one hand, as a pathogenic microorganism, it can colonize the gastric mucosa and result in chronic active gastritis, while on the other it can play a beneficial role in regulating immune cells in the stomach [23]. Interestingly, an individual’s microbiome can be modulated by diet [24], probiotics, or by interventions such as fecal transplantation [25].
Practice measures for controlling and preventing hospital associated Clostridium difficile infections
Published in Hospital Practice, 2019
Daryl Ramai, Aaquib Noorani, Andrew Ofosu, Emmanuel Ofori, Madhavi Reddy, James Gasperino
Clostridium difficile (CD) is regarded as the most common etiology of nosocomial diarrhea [1] . Over the past 20-years, hospital-acquired clostridium difficile infections (CDI) have become more frequent, more severe, and more likely to recur or relapse after standard therapy [2,3]. Additionally, cases of community-acquired CDI have been on the rise, particularly among younger patients, individuals without prior antibiotic exposure, those with frequent use of proton pump inhibitors (PPI) or specific classes of antibiotics, and those who live near farms and livestock [4]. Moreover, cases of CDI have been associated with significant mortality, morbidity, and burden on healthcare institutions [5,6].The severity of CDIs has been attributed to the emergence of hypervirulent strains such as ribotype 027 or NAP1 and ribotype 078 which have been documented worldwide including the United States, Canada, and Europe. To this end, practical measures for reducing infection are crucial to preventing and controlling the spread of CD. Mathematical models indicate that bundled interventions may reduce the spread of CDI by 14–84% and may also be cost effective [7,8]]. We review practice measures which can be applied by healthcare personnel and institutions for controlling and preventing CDI in the hospital setting.