Care Pathway for the Ward Management of patients with Clostridioides difficile Infection

Publication: 27/07/2017  --
Last review: 08/12/2020  
Next review: 08/12/2023  
Standard Operating Procedure
CURRENT 
ID: 5539 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2020  

 

This Standard Operating Procedure is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Care Pathway for the Ward Management of patients with Clostridioides difficile Infection

Aims

  • To standardise and optimise the care of the patient who has Clostridioides difficile infection (CDI).

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Background and indications for standard operating procedure

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Procedure method

  • All patients with confirmed Clostridioides difficile toxin positive infection are to remain in source isolation for the duration of their LTHT. If this is considered at any time not appropriate, then this should be discussed and agreed with IPC prior to terminating such source isolation.
  • A severity assessment should be carried out and documented on all patients with suspected or confirmed CDI by the medical team. Guidance on completing a severity assessment can be found on the guideline links above.
  • A risk assessment should be undertaken by medical team if on “other” antibiotic(s) or a PPI (such as omeprazole or lansoprazole).
  • Is an antibiotic still indicated? If so, is there a more suitable alternative? 
  • If on a PPI: why, for how long and what dose? Can the PPI be safely stopped, or could it be switched to an alternative acid suppressant such as an H2-receptor antagonist, e.g. ranitidine? If appropriate to continue PPI, could the dose be reduced?
  • Such reviews should also be documented.   
  • Assess patient suitability for CDI cohort facility with patient’s consultant (except Children’s CSU). These facilities are situated:

             J20 SJUH for those patients under 75 years.
             J17a SJUH for those over 75 years.
If considered not suitable for transfer to a cohort facility, then this should also be documented and the reason(s) why. If an adult patient remains in hospital and not in a CDI cohort facility, the decision regarding their most appropriate location should be kept under regular review. The patient will require-

  • Daily documentation of bowel type and frequency.
  • Review of NEWS/PAWS score.
  • Review patient for any abdominal cramps.

Escalate to medical team and IPC re any changes.

Patients with CDI can become septic and develop colitis.

Signs and symptoms include:

  • Acute patient deterioration.
  • Low blood pressure.
  • Tachycardia.
  • Decreased urine output.
  • Bowels not opened after type 5-7 stool.
  • Temperature over 38 and under 36 degrees.
  • Confusion.
  • Increased respiratory rates.
  • Abdominal pain.

Relapse

If within 28 days of the previous toxin positive sample, the patient has finished CDI treatment and had 3 consecutive episodes of type 5-7 stool +/- abdominal pain, pyrexia, raised WCC and raised CRP consider relapse of infection and escalate to medical team and IPC

Recurrence or Re-infection

If after 28 days of the previous toxin positive result the patient shows signs of CDI discuss with medical team/senior nurse and IPC.

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Provenance

Record: 5539
Objective:
Clinical condition:

Clostridium difficile Infection

Target patient group:
Target professional group(s): Secondary Care Nurses
Allied Health Professionals
Secondary Care Doctors
Adapted from:

Evidence base

Public Health England (2019) Updated guidance on the management and treatment of
Clostridioides difficile infection

LTHT guideline -  Diagnosis and Management of Clostridium Difficile Infection (CDI) in Adults (>16 years of age) (2016)

Approved By

Trust Clinical Guidelines Group

Document history

LHP version 2.0

Related information

Not supplied

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