One of the most common causes of antibiotic-associated diarrhea is Clostridium difficile. C diff is a type of bacterial infection that causes diarrhea and can be life-threatening. It’s important to know what it smells like so you’ll recognize it if someone has it! As a nursing student, we have the answer for you, including care plan information below.
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Disclaimer: The information presented in this article is not medical advice; it is meant to act as a quick guide to nursing students, for learning purposes only, and should not be applied without an approved physician’s consent. Please consult a registered doctor in case you’re looking for medical advice.
A-C Diff infection typically releases an unpleasant odor, but this varies from person to person and situation. Some people report smelling foul milk or rotten eggs. Others say their symptoms smell more like sulfur or garlic. If your patient reports such an odor from their stool, pay attention – they could have C diff!
Make sure to read on for our recommended nursing diagnosis and care plan guidelines.
What is C DIFF?
C. difficile, otherwise known as clostridium difficile infection, c diff, or CDAD, is a nasty bacterium that can cause extreme gastrointestinal distress in people of all ages. It’s important to know the signs and symptoms of this infection so you can seek treatment early on.
The infection primarily occurs in patients taking antibiotics, chemotherapy, and immunosuppressants (drugs that suppress the immune system).
It’s particularly prevalent when these agents are given orally. However, infection related to IV antibiotics is also possible.
Aging is a risk factor for CDAD. Up to 50 percent of cases occur in those older than 65 years old.
Additionally, those with other underlying problems are at an increased risk of contracting c diff. Common conditions associated with CDAD include:
- Malnutrition (i.e., poor diet, no vitamin intake)
- Hepatobiliary disease (i.e., cirrhosis, liver failure)
The Centers for Disease Control and Prevention (CDC) estimates 450,000 cases of C. difficile infection in the US each year. The CDC also reports that C. difficile is responsible for 14% to 29% of hospital-acquired infections, with a median duration of hospitalization being 11 days at an average cost per patient ranging from $17,500 to 25,000 dollars. As you can see, this bacteria is very costly on many levels and affects many patients across the country annually.
To reduce the risk of contracting C. Diff, patients should;
- Avoid taking antibiotics for conditions that do not require them
- Restrict dietary intake of dairy products following hospital discharge
- Follow appropriate hand hygiene practices during food preparation
- Wash hands thoroughly after using the toilet or changing diapers; consider probiotics if already on antibiotics
- Drink plenty of fluids and get regular physical activity while recovering from illness.
The infection can be spread from person to person through contact with infected feces.” If you suspect a patient has c diff, it’s important to keep them away from others.
As the infection progresses, patients may develop colitis (inflammation of their colon) and become septic (infection in their blood). In severe cases, they may die. If you or someone you know is experiencing any of these symptoms, please seek medical assistance immediately.
- Feeling lethargic (can progress to delirium)
- Clammy or sweaty skin; loss of appetite (can lead to malnutrition). If your patient is losing weight, eating less, and experiencing diarrhea, you must note this during your nursing assessment.
- Likely to have nausea and/or vomiting that is non-bloody or non-bilious (like bile but without anything in it).
- Diarrhea is watery, characteristically clear, and often accompanied by abdominal pain. It can be very severe with fevers, chills, and even dehydration.
- Most patients do not pass blood in their stool (this is a very serious sign of infection, especially if accompanied by fever, chills, rapid heart rate, or profuse sweating).
Nursing assessment helps determine what may be causing diarrhea. A sample of the patient’s stool can be tested to determine if the c difficile is present. Antibiotics may also be administered to repopulate the gut with good bacteria that will help fight off infection.
It’s not uncommon for patients to go through several rounds of antibiotics before they are discharged from the hospital and/or long-term care facility. If the patient has been on antibiotics recently, it’s important to test for c difficile.
Once a patient is suspected of having C. diff, the following diagnostic tests should be performed:
- Stool culture (a small sample of stool is collected and sent to a laboratory to determine if there are harmful bacteria present in the sample)
- Blood tests
- Test for anaerobic bacteria (bacteria that can only live in the absence of oxygen)
- Impaired Gastrointestinal Elimination
- Risk for infection related to antibiotic therapy;
- Acute diarrhea
- Chronic diarrhea
- Nausea and Vomiting
- Acute Abdomen; Diarrhea
- Dehydration related to diarrhea (see list of symptoms above)
- Altered nutrition: Less than body requirements related to loss of appetite secondary to nausea, vomiting, or diarrhea
- Imbalanced Nutrition: Less than body requirements related to chronic diarrhea
- Constipation (this can develop if the patient is experiencing chronic diarrhea)
As mentioned above, you must perform a complete nursing assessment to determine why the patient may be experiencing diarrhea.
If it turns out the patient has c difficile it’s important to take the following steps:
- Augment diet with oral supplements, including electrolyte solutions.
- Provide frequent oral care to minimize the risk of aspiration
- Providing diaper cream and baggie pants will also help prevent skin breakdown secondary to frequent diarrhea.
- Monitor for dehydration with ongoing assessments of the patient’s vital signs, skin turgor, capillary refill, and mental status-Frequently monitor the patient’s temperature (fever is a sign that the infection has spread throughout the body)
- Administering oral solutions such as Pedialyte or other electrolyte solutions as ordered by the doctor
The medical Dx for exposure to C difficile is:
- Toxic effects from waste products due to bowel perforation or necrosis, colonic bacterial infection with Clostridium difficile-associated disease (CDAD), which may or may not be preceded by C. difficile enterocolitis.
- C diff is highly contagious, so it’s important not to share or use any of the patient’s linens, blankets, and clothing without first washing them thoroughly.
If left untreated, this bacterial infection could lead to septic shock, with an extremely high mortality rate (upwards of 50%).
- Monitor bowel movements daily to check for consistency and frequency
- The nurse should administer prescribed medications as directed
- Provide emotional support to patient and family members
- The nurse should monitor vital signs for fever or other indications of infection
- Monitor frequency, consistency, and volume of stools
- Assess nutritional status by weight gain/loss
- The nurse should also provide education about food safety to reduce the risk of future infections.
- Administer antibiotics (by the nurse) as prescribed for infection control and eradication. The patient may have to take several rounds of antibiotics before they are healed.
- The nurse should provide emotional support to the patient and family members who may be experiencing feelings of anxiety and frustration during this time.
A hospital stay is a very traumatic event for most patients. Having to worry about battling an infection while recuperating from surgery can be very overwhelming and stressful. It’s important that every nurse is empathetic to their patient’s concerns and provides them with emotional support when they need it the most.
- Avoiding foods that contain raw fruits and vegetables.
- Cooked vegetables are recommended for the patient to eat (less likely for bacteria to cross the gut).
- Patients can begin eating other cooked foods, such as meat and cooked pasta or rice.
- It is okay for the client to eat cooked potatoes (white or sweet) as long as they are properly cleaned and cooked (CDC, 2013)
- Alcohol and caffeinated drinks
- Foods with high-fat content
- Food from buffets and salad bars because these areas might have contaminated foods, such as meat or salads that are not washed properly
- Proper hand hygiene is essential to prevent transmission of C Difficile bacteria to others.
- Wash hands thoroughly with soap and water before a meal and after visiting the washrooms
- Do not share things like beddings and personal items to avoid transmission
Patients who are not in the hospital or a long-term facility must wash their hands frequently with warm water and soap (CDC, 2013).
- Make sure that family members do not bring food that could contain C Difficile for the patient to eat.
- For anyone sick and has diarrhea, it is important to stay home from work or school and rest to prevent the spread of C Difficile to other people.
- If you are sick and have diarrhea, make sure that you are not out and about in a public place like a grocery store because you could contaminate produce with your feces (fecal shedding), which can then be passed on through food to others causing them to become sick, as well.
- If you are a caregiver for someone who has C Difficile or wants more information about it, don’t hesitate to contact your local health department and ask for information on the Clostridium Difficile disease.
If left untreated for too long, Clostridium difficile can lead to more serious complications such as colitis, toxic megacolon (a complication where stool gets stuck inside the colon), sepsis (infection in your blood), perforation in the intestines, and even death. To diagnose c difficile, one needs to look at their stools under a microscope.
In some cases, patients must be kept in isolation until their symptoms subside if they are part of a hospital outbreak. The treatment option recommended by most hospitals and long term care facilities are the following:
- Resistant antibiotics may be prescribed to attempt to kill off the infection. As mentioned earlier, a stool sample will be sent for testing and determining how resistant this particular strain is to antibiotics.
The length of management depends on whether the patient develops severe symptoms (diarrhea or colitis)
- Treatment is usually given until diarrhea, and abdominal cramps have subsided for at least 48 hours.
- Most patients will need to take an oral antibiotic for up to 2 weeks after symptoms have completely cleared. The CDC recommends that patients receive antibiotics from the family of clindamycin (e.g., Clindesse, Cleocin) or metronidazole (e.g., Flagyl).
- Fluoroquinolone (eg, ciprofloxacin [Cipro], levofloxacin [Levaquin]). These meds can take as long as three weeks to clear up the infection. If a patient develops severe side effects, this antibiotic is not recommended.
- Macrolide (eg, erythromycin [Erythrocin]). This drug treats mild to severe diarrhea from C. difficile by adhering to the bacteria and preventing its growth.
- Tetracycline (eg, doxycycline [Vibramycin]). This medicine is used to treat C. difficile when other antibiotics have not been effective. It does not clear the infection as quickly as some of the other antibiotics do.
- Fluorquinolone (eg, ciprofloxacin [Cipro], levofloxacin [Levaquin]). This antibiotic use to treat C. difficile and can work quickly to clear the infection.
-Dose: 200 mg orally once a day for 10 days
-Combination therapy (e.g., vancomycin [Vancocin], bacitracin-colistin). This type of therapy is sometimes the preferred treatment choice for severe colitis caused by C. difficile. It works quickly and may prevent life-threatening complications such as intestinal perforation.
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If you have a bacterial or viral infection, chances are this bacteria will not affect you, but if it does, there is a chance that your condition may become worse. It is important to know how C Difficile can be passed on and the precautions one should take when caring for someone who has it.
Because antibiotic medications reduce the “good” bacteria in your intestines, C Difficile can overgrow and cause an infection. But with a proper diagnosis of the disease, it is possible to remove this bacterium from your intestines and have a healthy body again. For more information, consult a healthcare professional or local public health department.