Take these actions if you suspect CDAD
The number of cases of Clostridium difficile-associated disease (CDAD) doubled between 2001 and 2005 to 301,200, according to a new report from the Agency for Healthcare Research and Quality (AHRQ).1
According to the report, 64.5% of all CDAD cases entered the hospital through the ED. "A decade ago, this figure was only 58%. So it seems that the proportion of patients admitted for C-difficile through the ED has been going up," says Anne Elixhauser, PhD, the study's author and senior research scientist at AHRQ. "If someone comes into the ED with diarrhea and they have been on antibiotics, C-difficile should be a consideration."
Theresa Patrick, RN, BSN, clinical resource nurse for the ED at University of North Carolina — Chapel Hill, says, "I expect we will be seeing an increase in these cases, because we are becoming more aware and are screening more."
Stool cultures are done for all diarrhea patients with risk factors, says Patrick. At triage, patients are asked about recent hospitalization or treatment with antibiotics, specifically clindamycin, penicillin, and cephalosporin. "This group of antibiotics is being heavily used for the treatment of MRSA [methicillin-resistant Staphylococcus aureus]. Therefore, patients receiving treatment for abscesses with diarrhea should raise a red flag," says Patrick. "Residence in a nursing home should also be a red flag at triage."
Signs that the CDAD infection could be life-threatening include hypotension, cardiac dysrhythmias related to electrolyte imbalance, and shock symptoms, says Patrick. "Place the patient on contact precautions immediately if you are concerned for CDAD," she says.
For the first six months of 2008, the ED at Hennepin County Medical Center in Minneapolis has seen six patients with confirmed diagnoses of CDAD, says William W. Larson, RN, assistant nurse manager of the ED.
At triage, ED nurses identify patients with diarrheal disease who were hospitalized within 72 hours of onset of symptoms or received antibiotic therapy in the previous two months. If patients are having persistent active diarrhea, they are placed in contact isolation. "These patients are also triaged as a higher acuity," he says.
Extra care is taken to be certain that all surfaces the patient came in contact with are well cleaned after their use, especially items such as commodes, bedpans, and surfaces that are accidentally exposed to diarrhea stool, says Larson.
ED nurses also obtain orthostatic vital signs to determine the patient's state of dehydration. "If the patient is actively having diarrheal stools while in the ED, a stool sample is collected and sent to the lab for analysis," Larson says. "Nurses follow universal precautions, including gloves and gowns."
Reference
- Elixhauser A, Jhung MA. Clostridium difficile-associated disease in U.S. Hospitals, 1993-2005. HCUP Statistical Brief No. 50. April 2008. Agency for Healthcare Research and Quality; Rockville, MD.
Sources
For more information about preventing hospital-acquired infections in the ED, contact:
- Shelley Calder, RN, CEN, MSN, Clinical Nurse Specialist, Emergency Department, Beth Israel Deaconess Medical Center, Boston. Phone: (617) 754-2310. E-mail: [email protected].
- Marianne Fournie, RN, BSN, MBA, Corporate Director, System ED Services, Methodist Healthcare, Memphis, TN. Phone: (901) 516-2357. Fax: (901) 516-2676. E-mail: [email protected].
- Mickey Heidt, RN, BSN, Emergency Department, St. Vincent Hospital, Portland, OR. E-mail: [email protected].
- William W. Larson, RN, Assistant Nurse Manager, Emergency Department, Hennepin County Medical Center, Minneapolis. Phone: (612) 873-5410. E-mail: [email protected].
- Theresa Patrick, RN, BSN, Clinical Resource Nurse, Emergency Department, University of North Carolina — Chapel Hill. Phone: (919) 966-8878. E-mail: [email protected].
- Karen Smith, RN, MSN, Director of Nursing, Emergency Department, MetroHealth Medical Center, Cleveland. E-mail: [email protected].
- Michelle Underwood, RN, BSN, MBA, Emergency Department, Nursing Supervisor/Clinical Nurse Educator, Baylor Medical Center at Irving (TX). Phone: (972) 579-5388. E-mail: [email protected].
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