Clostridium Difficile Infections in Hospitalized Patient Essay

Clostridium Difficile Infections in Hospitalized Patient Essay

Introduction

Clostridium difficile is gram-positive and an anaerobic bacillus that forms spores. It was first discovered in the year 1978 as a major cause of pseudomembranous colitis and antibiotic associated diarrhoea. Comparing to the methicillin resistant staphylococcus Aureus, there are increasing numbers of clostridium difficile.  It presents with fever, loss of appetite, abdominal pains and several episodes of diarrhea. It causes frequent outbreaks among hospitalized patients leading to organ damage, sepsis, toxic mega colon, asymptomatic carriage or pseudomembranous colitis. It mostly affects patients who have been on prolonged use of broad spectrum antibiotics and proton pump inhibitors, those who have a prolonged stay in a hospital, and the elderly patients over 65 years. It is associated with other diseases like; cancer, inflammatory bowel syndrome and kidney disease. The end results are prolonged admissions, additional medical costs, morbidities and mortalities. Treatment has persistently remained the same despite its severity and dramatic increase of the incidence in the past decade. Clostridium Difficile Infections in Hospitalized Patient Essay

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Topic Significance

  1. Difficile is a major cause of hospital acquired infections (HAIs) and is associated with over 500,000 infections every year in the US (Ragusa et al., 2018.) It colonizes up to 17% of hospitalized adults and the highest colonization rates are among elderly patients placed in institutions of long-term care, despite its increase in severity and incidence over the years. Patients diagnosed with primary CDI are managed with oral vancomycin or metronidazole and most of them experience CD-associated colitis and diarrhea with high mortality and morbidity (Ragusa et al., 2018). The drastic change in its epidemiology in healthcare settings has influenced its emergence as an issue of public health significance across the globe and in the United States.

The rapid change in the epidemiology of Clostridium difficile in hospital settings has contributed to its occurence as a disease of public health significance globally and in the United States. Similarly, at RWJ Barnabass Health, a drastic increase in the incidence of Clostridium Difficile Infection marked it as a disease of public health significance. Its increased burden placed significant financial constraints on the institution. However, the other costs associated with its management made the actual costs to be much higher. This drew the attention for the implementation of infection control measures using a multidisciplinary approach from a public health perspective.

BSN Care Practices to Use in the EBP Project

Ragusa et al. (2018) recommend hand hygiene as the most basic risk factor in HAIs. According to the recommendations provided by WHO, healthcare providers should practice hand hygiene through handwashing with soap and water in five steps; before contact with a patient or medical equipment, doing an aseptic procedure, after contact with a body fluid, patient contact, and contact with a patient’s environment. In resource-limited settings where there is scare water supply, healthcare providers can use alcohol-based hand rubs or sanitizers. Clostridium Difficile Infections in Hospitalized Patient Essay

PICO Question: Does handwashing with soap and water (I) compared to using alcohol-based hand sanitizer (C) decrease the incidence of hospital-acquired C. Difficile infections (O) among hospitalized patients (P).

How BSN Care Practice Help Quality of Care

Improve nursing staff knowledge about Clostridium Difficile (CD) Infections

This objective will increase staff awareness and understanding of CD and the reason it is a priority for the organization. In the inpatient units, CDIs are the second commonly occurring HAI the commonest in patients under mechanical ventilation. Its highest risk factor is endotracheal intubation, which disrupts the natural defense mechanism against the aspiration around the tube cuff (Gutiérrez, 2019). Highly infectious bacteria tend to gain access to the lower respiratory tract from aspiration during intubation.

Decrease the incidences of CDIs

This objective enhances a greater appreciation of the risk factors and etiology of CDIs.  The project will use the WHO clinical criteria for CDIs to determine the incidence of CDIs.

Decreasing CDIs-associated mortalities

CDIs related death rate ranges below 50% and can reach 76% in particular settings especially when caused by a high-risk organism. In the author’s healthcare organization, mortality ranges from 5%.

Reducing the duration of hospitalization

CDIs can be classified depending with the time when the infection starts. It can be directly as early (first 4 days) or late-onset (from the 5th day onwards). However, almost all CDIs cases happen within the 1st 4 days.

Reducing CDIs related medical-related costs

CDIs prolong the hospital stay by up to 9 days as well as increasing the healthcare costs. Hand hygiene practice will help to unburden the quality improvement costs shared between patients and the hospital. Clostridium Difficile Infections in Hospitalized Patient Essay

Part 1 Clinical Issues PICO Question

Write a good PICO question, it makes the rest of the process of finding and evaluating evidence much more straightforward.

You can use our PICO question to list terms to search.  Under each letter P, I, C, and O, list all the possible terms to use in your search. [Hint: Begin your Part 3 Literature Search here]

Determine the significance of the topic [why is important to improve this BSN care practice?] or the importance to nursing practice [how will the improved BSN care practice help quality of care?].

Task: Create an APA formatted two-page narrative using the 7th edition Manual following the rubric content criteria below.

The paper should include a title page, an abstract, two narrative pages, and a reference page.

Content of this paper should include:

  1. Clearly stated importance of topic
  2. Clearly stated PICO question guiding this project

PICO question clearly stated
P–Patient/Problem
I–Intervention
C–Comparison
O–Outcome

  1. Scientific writing in APA formatting: APA format including title page, abstract with key words, headings and subheadings [level 1 & level 2], intext citations, and Reference page
  2. Writing mechanics: Writing mechanics including appropriate grammar, spelling, punctuation, clarity, page length

 

My topic is Clostridium Difficile the PICO question would be:

Does handwashing with soap and water (I)

compared to using alcohol-based hand sanitizer (C)

decrease the incidence of hospital-acquired C. Difficile infections (O)

among hospitalized patients (P). Clostridium Difficile Infections in Hospitalized Patient Essay

References

Ragusa, R., Giorgianni, G., Lupo, L., Sciacca, A., Rametta, S., La Verde, M., Mulè, S., & Marranzano, M. (2018). Healthcare-associated Clostridium difficile infection: role of correct hand hygiene in cross-infection control. Journal of preventive medicine and hygiene59(2), E145–E152.

Lytvyn, L., Mertz, D., Sadeghirad, B., Alaklobi, F., Selva, A., Alonso-Coello, P., & Johnston, B. C. (2016). Prevention of Clostridium difficile infection: a systematic survey of clinical practice guidelines. infection control & hospital epidemiology37(8), 901-908.

McDonald, L. C., Kutty, P. K., & Kaplan, S. L. (2017). Clostridium difficile infection: Prevention and control. Up to324, 1-12. Clostridium Difficile Infections in Hospitalized Patient Essay

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