Evidence-Based Paper

Introduction

Clostridium difficile (C. diff), which causes severe diarrhea and inflammation of the colon (colitis), has been recorded as a life-threatening bacterium (Spanos, 2021). The bacterium has been categorized as a leading cause of healthcare-associated infections in the United States. According to medical research, C. diff causes approximately half a million infections in the USA each year. One major complication with C. diff infections is that they are likely to reoccur to most of the patients who get it in a period of two to eight weeks. (Spanos, 2021) argues that C. diff infections primarily affect older people who have been in long-term care facilities. However, research has shown that the C. diff infections rate is constantly increasing among young and healthy people at a lower risk of contracting the infections. Typically, C. diff infections are also likely to occur after long-term use of antibiotics.

In recent years, C. diff infections have occurred more frequently and have become difficult to treat. Moreover, the conditions are more severe and highly recurrent. According to studies, recurrent C. diff infections are on the rise due to the overuse and misuse of antibiotics among many Americans (Spanos, 2021). In addition, the number of C. diff cells shed in a patient’s stool increases each day highly. The C. diff bacterium is carried in some people’s intestines, which might occasionally spread to others. The most common signs and symptoms of moderate C. diff infections are watery diarrhea and abdominal pain. Severe C. diff infections are accompanied by fever, nausea, blood in the stool, and dehydration. In some extreme cases, enlargement of the colon and inflammation of the intestines might occur. Medical research on the bacterium has been conducted continuously over the years to reduce the rise and spread of C. diff infections in health care facilities (especially in the surgical unit). For best and reliable results, casual studies have been considered the best for most healthcare-associated diseases. They address the cause and effect variables and describe how they are related to each other.

Problem: The spread of C-diff

The C. diff bacterium is found in the feces of infected people. Healthy people can contract C. diff infections by touching surfaces such as bathtubs and commodes contaminated with feces. In a healthcare setting, nurses and other medical personnel can transfer the disease to patients through their hands if they touch these infected surfaces (Spanos, 2021). In the medical-surgical unit, healthcare personnel can spread C. diff through contaminated surgical equipment during surgery.

Medical research has linked C. diff infections in surgical patients to the extensive use of antibiotics. According to a study, C. diff infection is likely severe to people with underlying medical conditions such as a weakened immune system due to HIV and AIDS. Older people who are hospitalized are even at a higher risk of contracting C. diff. Many older people and patients with compromised immune systems who have to undergo surgical interventions have made the spread of C. diff in the surgical unit even worse. The C. diff spores can survive outside the human body for a long time. The bacteria can be found on simple things such as beddings and bed rails, where they are spread from one person to another through touching the beddings with hands.

In recent years, C. diff cases and severity in the healthcare setting have increased in the United States and many other countries in the world. The increase has particularly affected the medical-surgical unit more than any other unit of healthcare facilities. (Kulaylat et al., 2017) assessed the severity of C. diff infections in the surgical unit and the impacts on surgical patients and general hospitalized patients. Therefore, the prevention of C. diff infections and top management in the surgical unit has become dominant.

Search strategies

A search was conducted in the Medline and the Embase database (up to 29^th July 2021) to assess the severity of C. diff. Publications and documentaries in different languages on C. diff infections, enterocolitis, antibiotic-associated infections, and healthcare-associated diarrhea had to be found (Kulaylat et al., 2017). Documentaries on the infusion of stool from a healthy donor to an unhealthy person were also searched. Documents that addressed the procedures and methods of treating C. diff infections were also included in the search. Qualified medical librarians helped develop search strings even to find out current conference papers and recent websites of science that address C. diff infections. Documents that did not contain original information on C. diff treatment procedures and outcomes were excluded from the search.

A search was also conducted in a healthcare setting to determine the level of C. diff infections and how they can be eradicated in the medical-surgical unit. According to (Kulaylat et al., 2017), the eligibility of the methods of treatment used to lower the severity of the C. diff infections in the surgical unit and the other healthcare units have to be investigated. The search focused on treatment procedures that involved reviews and interviews on human feces. Treatment procedures that used cultured bacterial suspension were excluded.

Level of evidence

From the search results, the C. diff infection is a part of emerging life-threatening infections in the United States and other countries worldwide. According to the centers for disease control and prevention 453, 000 C. diff infection cases and 29 300 resulting deaths occurred in the United States in 2011. The death toll rose alarms and made the C. diff infection a public health issue in the country.

According to the search conducted in the healthcare setting, C. diff infection is the most threatening healthcare-associated infection in many clinics in the United States and other countries in the world. The infection has complexities linked to antimicrobial stewardship. Antibiotics damage the natural flora in the intestines and, in turn, destroy the army defensive provided by the microbiota in the colon. The destruction increases the risk of diarrhea and inflammation of the colon. Secondly, some antibiotics cause particular strains of C. diff that are incredibly resistant to those antibiotics.

Based on the available evidence from the research in the medical-surgical unit, C. diff infection was diagnosed among more than 2% of the patients who underwent a surgical procedure (Koch et al., 2020). The occurrence has continued to increase significantly over the years. In the surgical unit, some patients are at higher risk of contracting the C. diff infection. For instance, patients who underwent emergency surgery were at a higher risk than those undergoing elective operations. Moreover, some hospital conditions and characteristics such as north-eastern hospital location, large hospitals, urban hospitals, and teaching hospitals were associated with higher risks of C. diff infections. Patients with underlying health conditions such as small bowel resection and gastric resections were also at a higher risk of C. diff infection. (Koch et al., 2020) argue that patients who underwent appendectomy and cholecystectomy had a lower risk of C. diff infection. The mortality rate of patients who contracted C. diff infection was 95% higher than the other surgical patients.

Literature review

In 2018, a systematic review examined the severity of C. diff in the medical-surgical unit. This study aimed to find ways of reducing the severity of this bacterial infection in the surgical team. According to the study, C. diff infections would be reduced by specific interventions in the surgical unit. From the study results, the most effective interventions included daily to daily disinfection of highly touched surfaces such as bed rails and tables. Regular disinfection of surgical instruments after use and using new surgical instruments for every patient were also found to reduce the spread of C. diff infections in the surgical unit at a rate of 46% to 89%. Regular cleaning of patient rooms with disinfectant-based products also reduced the severity of C. diff in hospitals. From the study, intensified hand-hygiene practices were not operational in reducing C. diff infections rates. More effective methods for surgical unit decontamination, such as UV decontamination and hydrogen peroxide vapor (HPV), have been introduced in many healthcare facilities.

A recent meta-analysis of antibiotic-associated infections rated C. diff infections as the most common antibiotic-associated infections in healthcare facilities. The analysis focused on the increasing mortality rates and healthcare costs due to C. diff infections (Kulaylat et al., 2017). According to the investigation, C. diff infections range from mild to severe diarrhea and life-threatening colon inflammation. This analysis suggested quick identification of patients with C. diff infections and putting them under antimicrobial therapy. 90% of the patients responded positively to this therapy. (Kulaylat et al., 2017) advocate for prevention measures and C. diff infection control measures such as antimicrobial agents to be implemented in the medical-surgical unit.

In recent years, medical researchers have been interested in the colonization of C. diff. Researchers have considered asymptomatic carriers as a reservoir for the C. diff bacterium. Patients with toxigenic C. diff strains have a higher risk of developing an infection compared to non-colonized patients. Conversely, carriers of non-toxigenic strain are likely to be protected from developing a C. diff infection. However, the researchers found that converting non-toxigenic stress to a toxin producer made the risk assessment of colonization challenging. The researchers have suggested that more information is needed to assess the primary role of micro bacteria in progression from asymptotic colonization to C. diff infections.

A systematic review on intestinal microbiota showed that C. diff infection is a gastrointestinal complication directly related to strains in the intestines. The microbiota is found in the guts and intestines of humans and form roughly ten bacterial cells per gram in the stool. The microorganisms play a wide range of roles, from the digestion of complex carbohydrates to protecting the intestines against invasion by pathogens such as the C. diff bacterium. According to this review, the wide use of antimicrobials causes an imbalance of the intestinal microbiota and makes it easier for C. diff bacterium to infect the intestine. According to this review, primary infections by the C. diff bacterium were treated with metronidazole, and patients were advised to terminate antibiotics related to the infection. 32% of the patients experienced a recurrence of the infection after treatment, while 66% developed a chronic recurrence of the infection. Due to the poor treatment outcome of the C. diff infection, research on alternative treatment options has continued over the years.

Solution

Based on recent medical researches, the eradication of C. diff infections in the medical-surgical unit needs the intervention of numerous hygiene practices. Surgical unit personnel is required to maintain hand hygiene by using alcohol-based sanitizers or soap and water. Although the sanitizers do not kill the C. diff spores, they are highly operational in non-spore-forming organisms (Clark, Neihaus, 2020). Healthcare providers handling patients with C. diff infection should use disinfected equipment. General disinfection and cleansing of the health care environment are also essential in keeping away the C. diff bacterium. Environmental cleansing can be done using sodium hypochlorite solutions. Medical experts have also recommended immediate disposal of gloves after handling C. diff infected patients to prevent its spread to other patients.

Evidence-based practice can be adopted in the medical-surgical unit, including specific interventions on C. diff infections. Frequent disinfection of surgical instruments and highly touched surfaces such as bed rails using chlorine-based products is an effective intervention in many surgical units (Reese et al., 2021). In addition, non-touch method of disinfection methods such as UV light no-touch disinfection technology can decrease the severity of C. diff infections at a relatively high rate.

Conclusion

C.diff infection is a leading source of healthcare-associated infections in the United States and other countries worldwide. The high rates of infections are due to the failure and resistance to current treatment procedures. The rates have led to increased indisposition and mortality among surgical patients, clinical challenges, and economic challenges in many health care in the United States. Temporary and straightforward measures of eradicating the infection in the medical-surgical unit, such as cleansing and disinfection, have been implemented in many hospitals (Clark, Neihaus, 2020). Other measures, such as screening colonized patients and healthcare workers for C. diff, have helped detect the infection at early stages (Reese et al., 2021). The screening has also helped to reduce the risk of spreading the infection.

 References

Clark, C., & Neihaus, L. (2020). Implementing Hard Stops in the Electronic Records to Decrease Hospital Acquired C-Diff Infections. American Journal of Infection Control, 48(8), S45.

Koch, C., Edinger, F., Fischer, T., Brenck, F., Hecker, A., Katzer, C., … & Schneck, E. (2020). Comparison of qSOFA score, SOFA score, and SIRS criteria for predicting infection and mortality among surgical intermediate and intensive care patients. World Journal of Emergency Surgery, 15(1), 1-10.

Reese, S., Flaherty, B., & Wallace, M. (2021). Development of a Community-onset Clostridioides difficile Detection Tool to Prevent Delayed Identification of Infection. American Journal of Infection Control, 49(6), S12.

Spanos, C. P. (2021). Clostridioides difficile Colitis. In Acute Surgical Topics (pp. 65-69). Springer, Cham.

Kulaylat, A. S., Kassam, Z., Hollenbeak, C. S., & Stewart, D. B. (2017). A surgical Clostridium-associated risk of death score predicts mortality after colectomy for Clostridium difficile. Diseases of the Colon & Rectum, 60(12), 1285-1290.