In Bacteriology, Hospital aquired infections

The intestinal bacterium Clostridium difficile is one of the most common causes of nosocomial infections. Patients whose intestinal flora is disrupted due to the use of antibiotics are particularly susceptible and often suffer severe complications. These actions protect against an infection:

1. Identification

A quick diagnosis is important not only for the treatment of affected patients, but also to prevent the further spread of the pathogen. The two-phase diagnostic test has proven itself useful here: First the patient is tested for the enzyme glutamate dehydrogenase (GDH), and then, if the result is positive, a specific detection test for toxins A and B is performed.

2. Isolation

The Commission for Hospital Hygiene and Infection Prevention (KRINKO) at Robert Koch Institute recommends placing patients suspected of having a Clostridium difficile infection in their own room with their own bathroom as soon as possible.

3. Protective clothing

Nursing personnel are encouraged to wear single-use gloves and a long-sleeve gown when entering the room of an isolated patient and to remove these items before leaving the room. Visitors also should wear a gown.

4. Hand hygiene

Clostridium difficile bacteria are difficult to remove since the common alcohol-based disinfectants do not kill the spores completely. Hands should, therefore, be washed with soap and dried thoroughly. Also patients themselves should pay attention to their hand hygiene, especially after using the bathroom.

5. Disinfection of surfaces

The patient room and the bathroom, in particular the surfaces near the patient, should be treated daily with an effective surface disinfectant. If an outbreak occurs, the hall and adjacent rooms should also be disinfected.

6. Handling medical accessories

Medical devices, equipment, medical aids, and consumables should, if possible, remain in the patient’s room for as long as the patient is isolated and should be disinfected daily, when necessary. Avoid using rectal fever thermometers.

7. Handling laundry, dishes, and waste

Dirty laundry, trash, and dishes should be collected in closed containers. Using plastic outer bags is recommended for damp laundry and waste. A disinfecting wash cycle should be used to clean the laundry.

8. Patient transport

If the patient needs to be transported, the patient should perform thorough hand hygiene and be dressed in clean clothes. The means of transportation must be disinfected afterwards.

9. Staff training

Training for nursing and cleaning personnel is important to ensure that preventive actions are known and disinfectants are used correctly.

10. Monitoring

Hospitals should record all cases of nosocomial diarrhea in order to be able to take preventive actions as soon as possible. Frequent incidences of Clostridium difficile infections and infections that have a severe course must be reported.

Note: The recommendations are based on the official announcement on hygiene for C. difficile infections, published by Robert Koch Institute in 2019. The complete recommendations can be found here [in German only].

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