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

• Aims
• Background and indications for standard operating procedure
• Procedure method

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

• This care pathway aims to optimise the care of patients with known CDI and should be used in conjunction with one of the following guidelines:
• Diagnosis and management of Clostridium difficile Infection (CDI) in adults (>16 years of age)
• Clostridium difficile Infection (CDI) in children (<16 years of age).

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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:

Relapse

Recurrence or Re-infection

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