A 78 year old female is admitted from the hospital status post Total Knee Replacement. Orders are to complete IV antibiotics and begin Physical Therapy. Two days following admission, signs and symptoms consistent with C. Difficile develop. The Don and DSD place the patient on contact isolation, the physician is notified of a change in condition, and she orders Flagyl.
A room with two other female patients is all that is available; there is no option for a private room.
That sounds predictable.
How should a patient with C. difficile be managed in this scenario?
If the patient is using a bedside commode, where is it sanitized?
Must the Health care workers don gown and gloves when entering the room if they are not caring for the patient with C. Dif?
May the patient with C. dif. go to the shower? Go to activities, participate in therapy?
If not, when may the patient resume activities?
These are questions that frequently come up in LTC facilities. In many cases, facilities separate the affected patient from other patients and they do not share a common bathroom; instead, a bedside commode is utilized while the patient is symptomatic.
Some facilities interpret Contact Precautions as strictly applying to a patient confined to their room while there are active signs and symptoms of a transmissible disease, in this case active diarrhea.
In the case of C. Difficile, once the diarrhea has resolved, do you allow your patients to go out of the room on Standard Precautions as long as they are alert, able to comply with hand hygiene protocols and any potential source of contamination is contained?
What are your policies & procedures regarding the management of C. dif patients and isolation?
I couldn’t give you the answers to the above questions because I don’t have access to your policies and procedure. First of all you must be familiar with your policies & procedures regarding the management of C. Dif patients and Isolation precautions.
It’s vitally important for you, the ICP, DON or DSD to know where your manual is and to be actively engaged in its compliance with standards of care as supported by the CDC, APIC and your State Department of Public Health; these guidelines need to be specifically focused on the care of Long-term Care patients.