Survey of C. difficile-Specific Infection Control Policies in Local Long-Term Care Facilities

Laurie Archbald-Pannone

Department of Internal Medicine, Division of General Medicine, Geriatrics, and Palliative Care, Division of Infectious Diseases and International Health, University of Virginia, Charlottesville, USA.

DOI: 10.4236/ijcm.2014.57056                

Abstract

Introduction: The incidence and severity of Clostridium difficile infection (CDI) has been increasing and long-term care facility (LTCF) residents are at high risk given their age, co-morbidities, and high antibiotic exposure. Infection control policies are crucial for controlling CDI, but there are currently no regulatory guidelines in the United States. Therefore, we evaluated infection control policies in local LTCFs to define the CDI-specific policies and the administrative and staff understanding of CDI, so as to identify perceived barriers for compliance. Methods: IRB approval was sought and exemption granted, all 8 local LTCFs were asked to participate. Each facility was visited by study personnel who interviewed the administrative Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs) with distinct survey format. Infection control policies were then compared to the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities, 75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All facilities accept residents with active CDI and 2 had written CDI-specific infection control policies. All facilities had hand hygiene or glove use policies and 2 had policies for the use of sporicidal environmental cleaning. No facility restricted antibiotic use. Each facility has a policy to instruct their staff through in-services, either annually or upon new hire, but 33% (n = 7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs felt comfortable with the facility CDI policies, only 11 accurately restated it. ICPs felt the most relevant barrier to staff compliance was time constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10, 48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the increasing incidence and severity of CDI in LCTF, few of the facilities surveyed had CDI-specific policies. Despite CDI-specific training, there is a perceived knowledge and communication gap for staff caring for residents with CDI.

Keywords

Clostridium difficile Infection, Infection Control Policies, Long-Term Care Facilities

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	Bartlett, J.G. (2002) Antibiotic-Associated Diarrhea. New England Journal of Medicine, 346, 334-339.
[2]	Bartlett, J.G. (2006) Narrative Review: The New Epidemic of Clostridium difficile-Associated Enteric Disease. Annals of Internal Medicine, 145, 758-764. http://dx.doi.org/10.7326/0003-4819-145-10-200611210-00008
[3]	Bartlett, J. and Gerding, D. (2008) Clinical Recognition and Diagnosis of Clostridium difficile Infection. Clinical Infectious Diseases, 46, S12-S18. http://dx.doi.org/10.1086/521863
[4]	Zilberberg, M.D. (2009) Clostridium difficile-Related Hospitalizations among US Adults, 2006. Emerging Infectious Diseases, 14, 929-931. http://dx.doi.org/10.3201/eid1406.071447
[5]	Archbald-Pannone, L., Alcantara-Warren, C., Lyman, J. and Guerrant, R. (2009) Increased Incidence of Clostridium difficile Associated Diarrhea and Fluoroquinolone Use at the University of Virginia Health System. University of Virginia Journal of Medicine, 6, 45-48.
[6]	Bengualid, V., Umesh, K., Alapati, J. and Berger, J. (2011) Clostridium difficile at a Community Hospital in the Bronx, New York: Incidence Prevalence and Risk Factors from 2006 to 2008. American Journal of Infection Control, 39, 183-187. http://dx.doi.org/10.1016/j.ajic.2010.10.027
[7]	Iwashima, Y., Nakamura, A., Kato, H., et al. (2010) A Retrospective Study of the Epidemiology of Clostridium difficile Infection at a University Hospital in Japan: Genotypic Features of the Isolates and Clinical Characteristics of the Patients. Journal of Infection and Chemotherapy, 16, 329-333. http://dx.doi.org/10.1007/s10156-010-0066-4
[8]	Redelings, M.D., Sorvillo, F. and Mascola, L. (2007) Increase in Clostridium difficile-Related Mortality Rates, United States, 1999-2004. Emerging Infectious Diseases, 19, 1417-1419. http://dx.doi.org/10.3201/eid1309.061116
[9]	Wroblewski, D., Hannett, G.E., Bopp, D.J., et al. (2009) Rapid Molecular Characterization of Clostridium difficile and Assessment of Populations of C. difficile in Stool Specimens. Journal of Clinical Microbiology, 47, 2142-2148. http://dx.doi.org/10.1128/JCM.02498-08
[10]	Dumyati, G., Hannett, G., Thompson, A., et al. (2009) Clinical Features and Molecular Characterization of Community-Acquired Clostridium difficile Infections. Abstract IDSA.
[11]	Simor, A.E., Yake, S.L. and Tsimidis, K. (1993) Infection Due to Clostridium difficile among Elderly Residents of a Long-Term-Care Facility. Clinical Infectious Disease, 17, 672-678. http://dx.doi.org/10.1093/clinids/17.4.672
[12]	McDonald, L.C., Owings, M. and Jernigan, D. (2006) Clostridium difficile Infection in Patients Discharged from US Short-Stay Hospitals, 1996-2003. Emerging Infectious Diseases, 12, 409-415. http://dx.doi.org/10.3201/eid1205.051064
[13]	Bennett, R.G. and Greenough III, W.B. (1993) Approach to Acute Diarrhea in the Elderly. Gastroenterology Clinics of North America, 22, 517-533.
[14]	Lew, J.F., Glass, R.I., Gangarosa, R.E., Cohen, I.P., Bern, C. and Moe, C.L. (1991) Diarrheal Deaths in the United States, 1979 through 1987: A Special Problem for the Elderly. Journal of the American Medical Association, 265, 3280-3284. http://dx.doi.org/10.1001/jama.1991.03460240076031
[15]	Rao, A.S. and Bradley, S. (2003) Clostridium difficile in Older Adults and Residents of Long-Term Care Facilities. Annals of Long-Term Care, 11, 42-47.
[16]	Thomas, D., Bennett, R., Laughon, B., et al. (1990) Postantibiotic Colonization with Clostridium difficile in Nursing Home Patients. Journal of the American Geriatrics Society, 38, 415-420.
[17]	Riggs, M., Sethi, A., Zabarsky, T., et al. (2007) Asymptomatic Carriers Are a Potential Source for Transmission of Epidemic and Nonepidemic Clostridium difficile Strains among Long-Term Care Facility Residents. Clinical Infectious Diseases, 45, 992-998. http://dx.doi.org/10.1086/521854
[18]	Archbald-Pannone, L., Sevilleja, J. and Guerrant, R. (2010) Diarrhea, Clostridium difficile, and Intestinal Inflammation in Residents of a Long-Term Care Facility. Journal of the American Medical Directors Association, 11, 263-267. http://dx.doi.org/10.1016/j.jamda.2009.09.006
[19]	Simor, A.E., Bradley, S.F., Strausbaugh, L.J., et al. (2002) Clostridium difficile in Long-Term-Care Facilities for the Elderly. Infection Control and Hospital Epidemiology, 23, 696-703. http://dx.doi.org/10.1086/501997
[20]	Wilkinson, K., Gravel, D., Taylor, G., et al. (2011) Infection Prevention and Control Practices Related to Clostridium difficile Infection in Canadian Acute and Long-Term Care Institutions. American Journal of Infection Control, 39, 177-182. http://dx.doi.org/10.1016/j.ajic.2011.01.007