Infection Control in Clostridium difficile Case Study

This case study explores the implementation of infection control procedures in a patient with Clostridium difficile infection. It highlights the importance of hand hygiene, isolation, and prevention of cross-contamination. The study also emphasizes the need for practical knowledge in addition to theoretical understanding of infection control.

Practice Development
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Context : During placement within the Emergency department (ED), I
came across a case which provoked me to think and feel to give more
attention to this case. I was on regular first shift visit and was inquired by
other nurses to assist them for a lady patient (name – Mrs X, age – 70
years) in the adjutant room which was blocked due to Clostridium difficile
infection to her. I prepared myself with wearing personal protective
equipments (PPEs) like apron, gloves, cap and face mask prior entering
the room. I washed my hands and started assisting another nurse. After
the completion of activities, I removed the cardboard liner from the
commode and also ensured that I removed all my PPEs and dispose of
cardboard liner and all the patient waste. Nurse treating the patient also
confirmed that it is according to the hospital policy to dispose of all the
patient waste and PPEs and wash the hands prior to leaving the room. I
decided to give more attention to control infection in Mrs. X because there
are more chances of rapid rise of infection in her because she was
currently on the antibiotic treatment. Literature, also suggested that
patients above 65 years of age who were on antibiotic treatment are more
prone to infection with Clostridium difficile (Bartlett, 2017). Moreover,
control of Clostridium difficile is essential because there are chances of
infection spread to other people (Song and Kim, 2019). Reflection on this
assignment is essential because it would be beneficial as such situation
would improve knowledge. It is beneficial in improving the learning from
the situation. Literature suggested that reflection on an action rather than
in-action changes are helpful in improving knowledge through experience
(Goulet et al., 2016).
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Thoughts : I realised that I should not have personal empathy for the
patient in the isolated room because older patients might experience
stress and depression due to social isolation. Hence, I realised that I
should consider her request to shift her to the ward with other patients
because housing of Clostridium difficile infected patient with other
patients could spread infection at faster rate (Daniels and Kufel, 2018).
Moreover, NICE standard Principle of Infection Control also made it
mandatory that patients with Clostridium difficile should be isolated from
other patients (Loveday et al., 2014).
Feelings : I felt that confusion which I encountered during this infection
control procedure would have been avoided effectively. I experienced
confusion during the infection control because I did not foresee the
consequences and did not find the solutions for the potential problem at
the actual workplace. Identification of the potential problems would have
minimised confusion during actual infection control procedure for Mrs. X
because I did not read properly infection control policies of the ED prior to
my placement in ED.
Evaluation : I am sure, infection control procedure implemented for the
control of Clostridium difficile infection proved effective. Infection control
procedure was implemented with all the precautions to reduce infection in
the patient to reduce spread of infection to other patients. However, it
should be argued here that Clostridium difficile can not be completely
eradiated from the environment. I can assure that infection control
approach met most of the aspects of the evidence-based infection control.
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I ensured that my hands get disinfected before entering into the room as
well I ensured that I wore all the PEEs before entering the room. I covered
that bed pan liner with the disposable paper because I was aware that I
should go to the other place to reach macerator. However, few of the
things didn’t went according to the protocol like covering the cardboard
liners. I searched for the covers for cardboard liners; however, I couldn’t
find these covers. I learned that all the requirements should be in place
before starting any type of activity. This should be considered as serious
issue because spillage from the cardboard liners can lead to the rapid
spread of infection. Moreover, it also suggests that there should be
separate toileting facility for each patient with Clostridium difficile
infection. Hand is the most prominent source of contamination (Song and
Kim, 2019). Hence, care also should be taken during the opening the door
and touching the handle of macerator. Hence, I would suggest
management of the hospital to arrange the handle free doors and touch
free opening of the macerator.
Analysis : Prior to participation in the infection control; I was well aware of
the theoretical aspects of the infection control. However, after
participation in the infection control activity; I realised that practical
aspects of the infection control are the very important aspects for the
effective implementation of the prevention of infection procedure. Initially,
it was decided that I would be playing the role of assistance to the staff
nurse for prevention of infection which is specific to Mrs. X. However,
during actual practice; I realised that participation in every activity is
beneficial in understanding rationale for each activity and improving
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moral decision making. It would also give me confidence of handling such
cases independently in the future. Participation in the real time practice is
also helped in improving critical thinking and problem-solving abilities
which would be advantageous to identify alternatives to the current
practices for the improvement in the infection control activities. Moreover,
it is well understood that both theoretical and practical knowledge are the
important aspects for the effective implementation of the nursing practice
(Rahmati et al., 2015). This experience of prevention of infection helped
me in building of confidence in the infection control because I had belief
that I was unaware of the factors responsible for predisposition of the
infection. However, during real time practice I experienced that I identified
factors predisposing infection and took effective measures to control
these predisposing factors. Placement of paper towel over the bowel;
would not only be beneficial in the preventing cross-contamination, but
also be beneficial in maintaining dignity and privacy of the patient. Hence,
I placed paper over the bowel to perform the activities to align with
nursing principles and practices.
In this whole process, I maintained hand hygiene through hand washing
very accurately. It made me to realize that nurses and healthcare workers
are the most significant sources of infection and also most important
resources to achieve infection control. It is well established that hand
hygiene is at the heart of the infection control (Gammon and Hunt, 2019).
Hence, I appreciated that routine hand washing also has significant impact
on the infection control. Hereafter, policies and procedures for hand
washing should be in place for the effective implementation of infection
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control procedure. I was carrying out all my activities based on my
theoretical knowledge about infection control in general and was following
instructions given by the staff nurse. However, it was difficult for me to
rationalise the activities. However, it is well established that effective
infection can be achieved through specific action taken against targeted
microorganism (Mills et al., 2018).
Reframe: I should have used prior experience which I got while working
with patient with psychological problems to reduce her stress and relive
depressive state and ensure that after achieving control in her infection,
she would be shifted to another ward with other patients. I should not
have kept on asking questions to another staff member to improve my
knowledge and to ensure effective infection control. It was badly affecting
implementation of infection control procedure because my questioning
was disturbing whole environment in the room. I could have acquired all
the knowledge prior entering the room for infection control. Hand washing
is an effective way of infection control; however, use of alcohol gel would
have been more effective way of infection control (Haque et al., 2018).
Moreover, it would have reduced possibility of reducing cross-
contamination and minimising my concern over the infection control.
Future direction: I am sure, I can bring improvement in the Clostridium
difficile infection prevention through understanding accurate mode of
spread of Clostridium difficile infection. It would be helpful in taking action
to prevent spread of infection. I perceived that improvement in the form
of understanding mode of spread infection can considered as
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improvement for future procedures of infection control. I would like to
study more case studies from the literature to get more evidence-based
insight in the prevention control. Moreover, I will participate in more of the
such cases of infection control and corelate theoretical knowledge
obtained through reading case studies to the practical applications during
actual practice of infection control. However, it should be argued that
there is lot of variability exists in the literature for effective hand washing
procedure. This variability exists in terms of frequency of hand washing
and type and concentration of disinfectant used for hand washing
(Gammon and Hunt, 2019). Hence, there is possibility of cross-
contamination owing to practicing different hand washing procedures at
different time points. Effective procedure for the hand washing specific to
the current clinical setting can be established through trial and error of
different procedures and adopting the most effective procedure.
Establishment and validation of clinical setting specific procedure would
be helpful in improving confidence of healthcare providers and
consequently improving the patient care ensuring safety of patient.
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References:
Bartlett, J.G. (2017). Clostridium difficile Infection. Infectious Disease
Clinics of North America, 31(3), pp. 489-495.
Daniels, L.M., and Kufel, W.D. (2018). Clinical review of Clostridium
difficile infection: an update on treatment and prevention. Expert Opinion
on Pharmacotherapy, 19(16), pp. 1759-1769.
Gammon, J., and Hunt, J. (2019). The neglected element of hand hygiene -
significance of hand drying, efficiency of different methods and clinical
implication: A review. Journal of Infection Prevention, 20(2), pp. 66-74.
Goulet, M.H., Larue, C., and Alderson, M. (2016). Reflective Practice: A
Comparative Dimensional Analysis of the Concept in Nursing and
Education Studies. Nursing Forum, 51(2), 139-50.
Haque, M., Sartelli, M., McKimm, J., and Abu Bakar, M. (2018). Health care-
associated infections - an overview. Infection and Drug Resistance, 11, pp.
2321-2333.
Loveday, H.P., Wilson, J.A., Golsorkhi, M., Tingle, A., Bak, A., Browne, J.,
Prieto, J., and Wilcox, M. (2014). epic3: national evidence-based guidelines
for preventing healthcare-associated infections in NHS hospitals in
England. Journal of Hospital Infection, 86(1), pp. S1-70.
Mills, J.P., Rao, K., and Young, V.B. (2018). Probiotics for prevention of
Clostridium difficile infection. Current Opinion in Gastroenterology, 34(1),
pp. 3-10.
Rahmati, S.N., Alami, A., Khosravan, S., Mansoorian, M. R., and Ekrami, A.
(2015). Academic training and clinical placement problems to achieve
nursing competency. Journal of Advances in Medical Education &
Professionalism, 3(1), pp. 15-20.
Song, J.H., and Kim, Y.S. (2019). Recurrent Clostridium difficile Infection:
Risk Factors, Treatment, and Prevention. Gut and Liver, 13(1), pp. 16-24.
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