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Clostridiodes Difficile in Care Homes

strict guidelines on infection control is of paramount importance in ensuring the safety of both service users and staff. {{org_field_name}} adheres fully to The Health and Social Care Act 2008: Code of Practice for Health and Adult Social Care on the Prevention and Control of Infections and Related Guidance (the Hygiene Code), with which it must comply to ensure registration with the Care Quality Commission under the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010.

Legal Considerations and Statutory Guidance

{{org_field_name}} will adhere to the following infection control legislation

1. the Hygiene Code
2. the Health and Safety at Work, etc Act 1974
3. and the Public Health Infectious Diseases Regulations 1988, which place a duty on {{org_field_name}} to prevent the spread of infection
4. the Control of Substances Hazardous to Health Regulations 2002 (COSHH), which place a duty upon employers to control dangerous substances in the workplace
5. the Reporting of Incidents, Diseases and Dangerous Occurrences Regulations 1995 (RIDDOR) which place a duty on {{org_field_name}} to report outbreaks of certain diseases as well as accidents such as needle-stick accidents.

Under the above guidance {{org_field_name}} understands its legal and moral duty to protect staff and service users from the risk of the transmission of bacterial infections wherever possible.

Aim

{{org_field_name}} aims to prevent the spread of bacterial infections amongst service users, visitors and staff.

Policy Background

Clostridium difficile is a spore-forming bacteria naturally present in the gut of up to 3% of healthy adults. In normal circumstances it rarely causes problems. However, it can cause severe illness when antibiotics are used that disturb the balance of the “normal” bacteria and create the conditions for it to proliferate and produce toxins.

Illnesses caused range from mild to severe cases of diarrhoea through to severe inflammation of the bowel, colitis and, at worst, perforation of the intestine and peritonitis. Other common symptoms include:

• fever
• loss of appetite
• nausea
• abdominal pain or tenderness.

Fortunately, most people develop only a mild illness and stopping the antibiotics, together with fluid replacement, usually results in rapid improvement. Sometimes, however, it is necessary to give specific antibiotic therapy against Clostridium difficile itself.

Clostridium difficile can spread from person to person because those suffering from diarrhoea shed spores in their faeces. The spores are very resilient and can survive for a long time in the environment. They are usually transported on the hands or uniforms of healthcare staff or on contaminated equipment such as commodes and bedpans. Unfortunately those victims with diarrhoea, especially if severe or accompanied by incontinence, may unintentionally spread the infection to others by direct contact, which leads to characteristic “outbreaks” of Clostridium difficile in hospitals and care homes.

The elderly are most at risk, with over 80% of cases reported in the over 65 age group, as well as most deaths.

It is difficult to diagnose Clostridium difficile infection on the basis of its symptoms alone so the infection is normally diagnosed by carrying out laboratory testing of faeces samples. Government guidance is that all health and social care organisations should recognise Clostridium difficile as the potentially life-threatening infection that it is and make the fight against it a key priority.

Procedure

1. Symptomatic service users will be cared for in their own room. Where they do not have an en-suite toilet they will be designated a specific commode for their exclusive use.
2. Faecal samples will be obtained and sent for analysis as required by the GP.
3. Staff will use standard infection control techniques (eg disposable gloves and aprons, careful hand washing practice, use of antibacterial alcohol gels, etc).
4. Environmental cleaning will be increased and performed using detergent and hot water followed by a chlorine-releasing solution at concentrations of 10:00 pm.
5. Soiled linen will be bagged and dealt with separately as potentially infectious.
6. Infected service users will be encouraged to wash their hands after using the toilet or commode, and before eating.
7. Unnecessary visits will be discouraged. Those who choose to visit will be asked to wash their hands as they enter and leave the care home and comply with all other hygiene practices.
8. The local infection control team will be contacted if a number of service users are diagnosed with Clostridium difficile.
9. The home will be closed to admissions until 48 hours after the last symptomatic resident has recovered.
10. Symptomatic staff should go off duty immediately and go to see their GP. They should have a faecal sample taken and should remain off work until symptom-free for 48 hours
11. If any infected service user requires admission to hospital the receiving unit will be informed of the outbreak so that they can institute appropriate measures.

Implementation

All staff are responsible for the implementation of this policy. Overall responsibility for ensuring the policy is implemented, monitored and reviewed rests with the care manager and the Infection Control Lead for {{org_field_name}}.

Information on the policy will be:

1. circulated to all staff
2. provided to all new employees
3. included in the Infection Control Policy.

Training

All new staff should be encouraged to read this policy as part of their induction process.

Those with specific duties and responsibilities under the policy will be offered additional training.

Clinical staff and those with special responsibilities for infection control and risk assessment should also be offered additional advanced training on infection control.

infection control and risk assessment will receive advanced training on infection control.

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Responsible Person: {{org_field_registered_manager_first_name}} {{org_field_registered_manager_last_name}}

Reviewed on: {{last_update_date}}

Next Review Date: {{next_review_date}}

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