Aspects of Infection Control

Introduction

Clostridium difficile or C. difficile is a dangerous bacterium that infects the bowel. It may cause intestinal problems such as colon inflammation, which is scientifically referred to as simulated membranous colitis. Its major signs include placid or even rigorous diarrhoea. Clostridium difficile spores and bacteria are found in human faeces. Any individual may acquire the illness by touching his or her mouth after coming into contact with bacteria-stained human wastes. Moreover, the human workforce in the medical field may spread the bacteria to patients, especially when they have contaminated hands. Clostridium difficile poses a major threat to the elderly, those who are under antibiotic medication, and/or those with other illnesses. However, clostridium difficile does not cause any harm to people who do not have a history of health complications. For individuals who take some antibiotics or high dosages for a long period, the medication can negatively influence the gut bacteria by destroying it. Such a person may end up developing the clostridium difficile bacteria. The most common symptoms of clostridium difficile infection are aching abdominal cramps, soggy diarrhoea, which may often be bloody, fever, and signs of dehydration such as headaches, dry mouth, or reduced rates of urination. Clostridium is the main cause of diarrhoea in long- term care centres and hospitals in the majority of industrialised countries. Hence, as the paper reveals, organisations face significant challenges when trying to manage clostridium difficile bacteria. However, the paper begins by analysing the workplace setting with reference to the Infection prevention and control theory.

Background to the Infection Prevention and Control Theory

Infection prevention and control theories discuss the measures taken to control or prevent infections to enhance protection of the vulnerable people from acquiring an infection both in the community or while getting medical attention due to health problems in different settings. Therefore, an analysis of the workplace setting has to be carried out. Hygiene is the most important infection, prevention, and control principle. Workers in the healthcare field are at a greater risk of exposure to infectious diseases. Such workers may include people working in animal hospitals, funeral homes, dentistry, medical hospitals, and clinics. In general, employees are required to have some prevention measures in place. Such measures may include the identification of infectious diseases in the workplace, development and implementation of an exposure control plan, and/or supervision, training, or even educating workers on safety procedures in the workplace. Besides, precautionary mechanisms may include informing workers on the modes and means of exposure to infections. Besides offering vaccination to employees, employers should purchase safety-savvy medical gear and equipment while at the same time advising workers to seek medical attention as recommended, especially during exposures.

Challenges of Managing Clostridium Difficile in the Workplace

Non-adherence to Standard Precautionary Measures

According to Dallal et al. (2002), to manage clostridium difficile in the workplace, principles of infection prevention and control must be applied. Employees or colleagues in the workplace must be knowledgeable on the issue. However, if this principle is not observed, workplaces may have to face a myriad of challenges such as failure to conform to the set precautionary mechanisms. Standard precautionary measures are the general conditions that should be adhered to in the workplace to prevent C. difficile infections in any setting. Such measures outline the minimum infection prevention methods, which may be applicable to all patients, irrespective of whether they have been confirmed infected or just suspected to be infected. Most of these factors are also imperative in the workplace setting as precautionary measures. Non-adherence to these standard prevention and control measures creates a challenge of managing clostridium difficile. Numerous standard precautionary measures where this challenge has been common will be explained further.

Poor Hand Hygiene

In any workplace, people have different backgrounds. Hence, they do not operate on a standard level of hygiene. In case of an infected employee in the workplace where hand hygiene is not observed, the potential risk of more infections is prevalent. Hand hygiene entails washing hands, especially after leaving the washrooms where the bacterium may be present (CDC, 2016). Hand washing should be done using water and a non-microbial or antiseptic soap. Glove use should be a prioritised prevention precaution for people who work in the medical field or even those whose work involves bodily contact with individuals. Being in contact with the mucous membranes, excretions, or even body secretions raises the chances of getting infections because the contact causes the bacterium to penetrate the skin pores to the extent of causing infection. If the use of gloves is not adhered to, anyone who is exposed to a clostridium difficile-infected patient may also become infected.

Improper Management of Staff Member Illness

Clostridium difficile has infectious agents that can be acquired through exposure to body fluids and blood. In a working environment, volunteers, guests, and staff should be wary of any blood or body fluids that may be infectious (Guzman-Cottrill et al., 2013). Therefore, in a work environment, it has been a challenge to convince workers to avoid sharing personal items such as razors, spoons, or handkerchiefs. Most of the work environments do not restrict the entry of individuals with open skin wounds. Such workers may allow the entry of CDI bacteria into the workplace. The wounds stand a higher chance of cause the spread of clostridium difficile. If the work environment does not uphold such restrictions, it becomes a challenge when it comes to managing clostridium difficile.

Most employees in an organisation share various objects in the workplace. An example may be kitchen utensils and appliances in the agencies. Such places are not regularly disinfected in various places of work. In case one member is infected, he or she may spread infections to all colleagues who come into contact with the objects (Mayfield, Leet, Miller, & Mundy, 2000). The infection may also be spread through direct contact with the infected person. It is also a challenge to carry out some of the control measures such as health screening of visitors in the workplace. This situation makes it logically impossible to perform such a task since it will negatively affect time-productivity rate. Some clients may regard the process as derogatory and an ethic breach, although it is recommended during periods of outbreaks as a stringent prevention and control mechanism. Staff members who happen to be infected with C. difficile pose a major risk to their colleagues and even visitors. Many of the employees fail to disclose such health information to their supervisor. Hence, they put everyone at a risk of infection. Such behaviours pose a great risk of contacting clostridium difficile in the workplace. Hence, to prevent such a scenario of exposing everyone to the infection, regular clinical evaluations and checkups are supposed to be done in the workplace by a qualified health provider.

Very few people are aware of other individuals’ respiratory illnesses such as congestion, cough, or even rhinorrhea. Covering of mouth, nose, or both when one is coughing and/or sneezing is a challenge to many employees since the process occurs abruptly. Failure to do so transmits viruses or bacteria to a distance of roughly five metres. Any clostridium difficile-infected worker who fails to observe this precautionary measure of respiratory etiquette puts everyone else in jeopardy and hence the reason why management of clostridium difficile has become a challenge in places of work (Guzman-Cottrill et al., 2013).

Non-adherence to Transmission-Based Safety Measures

Transmission-based safety measures (TbP) act as a complement to standard safety measures in patients who are suspected (or known to have) C. difficile. TbPs are used when standard precautions fail to eliminate the bacteria’s transmission route. However, in the workplace, employers and employees find it challenging to determine when to apply TbPs. For instance, contact isolation precautions entail safety measures that reduce the contact between individuals who are suspected or confirmed to suffer from CDI in the workplace. Such contact is the major cause of CDI. Contact transmission occurs through direct touch to the patient, contact with the patient’s environment, or by use of contaminated equipment or gloves. According to Mayfield et al., (2000), the precaution requires a private room where the patient is put in isolation, equipment that is personally dedicated to the patient. Such equipment should be disposable or highly disinfected after every use. Moreover, appropriate door signage in green should be in place to inform people of the patient’s existence. The patients should also be informed or educated on policies regarding their condition. Therefore, in a work environment where contact precautions are not enforced by taking the patients to a medical facility exposes the whole workforce to CDI. The policies may fail to be enforced due to ignorance by the co-workers on the health status of their colleagues. Besides, the high-cost implications involved in contact precautions may also be the reason why many organisations fail to adhere to the established measures.

Transmission of CDI occurs when droplets, which contain microorganisms, are emitted from an infected person and projected to a short distance of around 4 feet. People may be exposed to infected people’s mucous membrane through the mouth, eyes, or nose when they are probably sneezing, coughing, spitting, speaking, or even when they undergo tracheal suctioning. If someone is a medical practitioner, various precautionary measures have to be addressed in the workplace to control and prevent further infections among employees or other parties (Mayfield et al., 2000). Such measures include respiratory and eye protection, removal of masks before leaving a patient’s room, and/or ensuring a notification to the receiving department on the status of the isolated patient during transportation where off-unit testing is a necessity. These precautionary measures are supposed to be followed strictly. However, places of work have been lenient and hence the challenge in managing CDI in the workplace.

Diagnosis Difficulties

It is difficult to prevent CDI in hospitals, nursing homes, and in the workplace. A further challenge is posed during diagnosis. In fact, the level of correctness or sensitivity in identifying the clostridium difficile toxin is roughly 72% in virtually all the diagnostic reviews and tests used. Hence, if tests are done in the workplace on someone who potentially seems to be suffering from CDI, further tests should be carried out to validate the prior tests, especially when the results turn out to be negative. In some cases, patients have succumbed to clostridium difficile infection due to complete belief in a negative test, which was essentially a false negative. Therefore, it is imperative to understand that the current testing is not wholly sensitive. Hence, retesting, especially when symptoms, are feasible is very important. Numerous issues influence treatment. For instance, to prevent the reappearance of CDI, a certain treatment therapy should be done (Johnson, Schriever, Galang, Kelly, & Gerding, 2007). There only exist two agents in CDI medication, namely, vancomycin and metronidazole, whose recurrent rate is roughly 21%. Secondly, another issue that affects treatment is the technique to be employed in the management of patients with the fulminant disease or are in severe illness without having them undergo a colectomy (Dallal et al., 2002). A colectomy is the complete or one-sided elimination of the colon. Therefore, for a successful diagnosis, a treatment that does not lead to 25% to 30% diarrhoea reappearance rate with patients is required. Vancomycin and metronidazole, which are the presently accessible treatment options, are microbial.

Hence, the drugs disrupt the patient’s normal flora to the extent of leaving him or her with a susceptibility of a relapse or having higher chances of infecting other people in the work environment. A higher probability shows that when re-infection occurs, it happens mostly to other parties other than the originally infected persons. To combat this problem of re-infection to either the patient or a secondary body, new possibilities of treatment have emerged. One of the new treatment strategies include drugs that have a very narrow spectrum to ensure that the fauna remains untouched in the process of eliminating the clostridium difficile bacteria. In as much as Metronidazole has been the main drug to treat CDI, various strains of clostridium difficile are resistant. Further research has been carried out to investigate the efficacy levels between vancomycin and metronidazole. Teasley and his team carried one of the studies out in 1983 in a Minneapolis hospice while Wenisch, an Austrian, did the other research in 1996. The results of both types of research showed minimal and/or no disparities regarding the management of diarrhoea and the effectiveness of metronidazole and vancomycin. The rate of failure is considerably low while the rate of recurrence is substantial for vancomycin. Reappearance refers to the situation where one gets diarrhoea after it had disappeared for a while whereas failure refers to the situation where a patient undergoes treatment, although the situation does not cease. On the same research, metronidazole is similar to vancomycin where it has low rates of failure. However, this rate is rising considerably and hence the challenge that many organisations are facing in the process of managing clostridium difficile.

Failure to Provide Proper Education and Training on Clostridium Difficile

The third major challenge of controlling clostridium difficile revolves around poor or insufficient education and training on CDI management among members of the workplace (Mayfield et al., 2000). Persistent education or training of staff is necessary for competence maintenance to ensure that procedures and policies on infection prevention are properly followed and clearly understood. All staff members in the workplace, including contracted personnel such as workers from an external body or auxiliary service providers, must go through training and education led by the relevant personnel regarding job-specific infection prevention practices in addition to the choice and use of private defensive gear. This training has been overlooked in many organisations that see it as a waste of time and financial resources. The management knows the cost implications for hiring exemplary and competent training personnel are exemplary. For instance, in a hospital setting, education and training should be offered by highly qualified and experienced medical practitioners who, in turn, educate junior level employees. Moreover, training also happens during orientation to the workplace to inform new employees about the regulations, rules, and techniques applied in preventing or mitigating the infection of CDI (CDC, 2016). The training should be repeated at least annually to refresh the employees’ knowledge and/or provide requisite information to new employees. However, failure to observe education and training requirements has made it complex to handle CDI in the workplace.

Risky Injection Practices

Needle use is part of doctors and other medical practitioners’ day-to-day experience in their workplace. They are obligated to use needles for administering medication through direct vaccination such as insulin jab or through a central line (PICC line). Since the needles may be infected by the patient’s blood, the possibility of the programme member of staff acquiring CDI is high, especially in case an accident occurs where the medical practitioner sustains needle-stick injuries (CDC, 2016). Moreover, medical staff members are required to handle needles safely when injectable methods of medical administration are employed. However, carelessness when handling such risky apparatus has posed a problem in the management of clostridium difficile in the workplace. In addition, volunteers and housekeeping staff members have contracted the bacteria while cleaning clothes or clearing rooms, especially in hospital locations where contaminated needles have been disposed inappropriately.

Poor Handling of Infected Laundry

Clothing that is soiled with stool, vomit, or blood should be discarded to prevent infectious bacteria transfer, which may cause CDI to the cleaning individual or another external party (Poutanen, 2005). Many office cleaners do not observe these precautionary measures. Hence, if the owner of the clothing is infected with clostridium difficile, such an exposure has the potential of infecting others. Therefore, the recommendations that should be strictly followed to avoid a further spread of CDI include not shaking soiled clothing. Such garments should be kept in a polythene bag to keep the fluids until disposal. In addition, soiled clothes should be kept separate from other materials. The soiled linen should be washed in hot water mixed with detergents. Such stringent regulations should be followed strictly. If not so, it will be difficult to manage the infection and control of CDI in the workplace.

Poor Management of Special Populations

In healthcare, some special categories of people depend on life-support machines. Special people are categorised as such based on their risk susceptibility to acquiring infections and/or developing a serious disease once infected. This category of people also has a higher probability of spending more time in health facilities seeking medical care. These routine visits to medical practitioners expose them further to infections. For instance, patients with an immunodeficiency syndrome, which may be congenital, asplenia, or even acquired, are highly susceptible to acquiring CDI because their immunity has been weakened. Hence, any exposure to risk factors that can cause clostridium difficile bacteria infection should be addressed (Poutanen, 2005). However, even in a hospital setting, medical practitioners are not keen when handling such patients.

Hence, the spread of clostridium difficile may go unnoticed until it has infected many people in the workplace. Moreover, patients who have undergone immunosuppressive therapy for inflammatory bowel disease treatment, for example, ulcerative colitis or Crohn’s disease, also have a high predisposition to CDI. The underlying reason for the increased probability of acquiring CDI is that treatment for inflammatory bowel disease usually involves potent biological and chemical agents that suppress the immune system of the body to encourage the functionality of organ transplant in the body. The most vulnerable patients include stem cell sick people whose bodies decline the transplanted organ or cells. Hence, when exposed to CDI, they would easily be infected through bodily contact or even through sneezing, coughing, and other means from an infected individual. Therefore, as a medical practitioner, it is imperative for precautionary techniques to be employed such as isolation of the patients. Since this plan is not the case in many hospitals, especially in rural areas, medical practitioners are highly exposed to CDI.

Workers in other fields may be exposed to clostridium difficile, especially if they are not competent enough in their line of duty. Unskilled workers pose a major problem when it comes to managing clostridium difficile in the workplace. Incompetent medical staff members do not follow ethics or protocols that guide medical practitioners. Therefore, they expose others, including themselves, to CDI. Moreover, according to CDC (2016), regular checks and audits of the staff members are not carried out as stipulated to ascertain whether they strictly stick to disease prevention policies and practices that help to curb the risk of contracting CDI. This situation reveals why workers in the medical field such as nurses or doctors who are exposed to their CDI patients end up contracting clostridium difficile.

Conclusion

With reference to the infection prevention and control theory, it is important to perform routine health care practice surveillance of activities. Such a process can help to detect any outbreak, including the spread of clostridium difficile. This routine surveillance includes the inspection of healthcare-associated infections and the measures that have been deployed to enhance the process of infection prevention such as hand hygiene. As revealed in the paper, once these checks are either not performed and/or are done irregularly, clostridium difficile will be promoted instead of being controlled or depleted. Healthcare Associated Infection is among the major surveillance forms. In this inspection protocol, only designated personnel collect, manage, or even analyse the relevant data on the levels of clostridium difficile contamination. Inspection intelligence is prepared regularly. The distribution of such reports is also done regularly or periodically to enhance any follow-up. For instance, if the HAI surveillance for CDI is seen to be high, some medical procedural assessments are done for disease control. However, if the HAI surveillance is inappropriately done or even poorly analysed, false information regarding the level of CDI penetration will be reviewed. As revealed in the paper, such erroneous treatment will negatively influence the management of clostridium difficile in a medical work environment. Overall, workplace settings are facing a major challenge when it comes to addressing or managing the spread of clostridium difficile.

Reference List

CDC. (2016). Fundamental Principles of Infection Prevention | Infection Control and Prevention Plan for Outpatient Oncology Settings. Web.

Dallal, R., Harbrecht, B., Boujoukas, A., Sirio, C., Farkas, L., & Lee, K. (2002). Fulminant Clostridium difficile: An Underappreciated and Increasing Cause of Death and Complications. Annals of Surgery, 235(3), 363-372.

Guzman-Cottrill, J., Ravin, K., Bryant, K., Zerr, D., Kociolek, L., & Siegel, J. (2013). Infection Prevention and Control in Residential Facilities for Paediatric Patients and Their Families. Infect Control Hosp Epidemiology, 34(10), 1003-1041.

Johnson, S., Schriever, C., Galang, M., Kelly, C., & Gerding, D. (2007). Interruption of Recurrent Clostridium difficile-Associated Diarrhoea Episodes by Serial Therapy with Vancomycin and Rifaximin. Clinical Infectious Diseases, 44(6), 846-848.

Mayfield, J., Leet, T., Miller, J., & Mundy, L. (2000). Environmental Control to Reduce Transmission of Clostridium difficile. Clinical Infectious Diseases, 31(4), 995-1000.

Poutanen, S. (2005). Treating C. difficile. Canadian Medical Association Journal, 172(4), 448-448.