Sample Care Plan for Patient/Residents With

Sample care plan for patient/residents with

Clostridium difficile infection (CDI)

Version 2

December 2012

Please sign and date for each shift to document compliance with care plan

Precautions for caring for patient/residents with suspected/known CDI

Problem
Infectious diarrhoea
Aim:
To treat infection & prevent cross infection to other patient/residents visitors and staff.
Stool specimen to lab
Date:______
Stool specimen result
Date:______
Infection Prevention & Control informed
Date:____/____/_____
By Whom______
Dept Public Health informed:
Date:___/____/______
By whom:______
Date Precautions commened: __/__/___
Signed:
______
Discontinue Precautions once the patient/resident, has had no diarrhoea for at least 48 hrs and has had a formed or normal stool for that patient/resident.
Date:______
Record patient/resident’s history of CDI
Date:______
Signed:______ / CONTACT PRECAUTIONS (in addition to Standard Precautions)
1Inform the patient/resident & family of the need for being placed in a single room.
· Doctor has assessed and informs patient/resident of diagnosis.
· Provide the patient/resident and family with the “Clostridium difficile Patient/resident Information Leaflet” and Hand Hygiene leaflet
Date :______Signed:______
2. Place patient/resident with suspected or known infectious diarrhoea in a single room with clinical hand washing sink and en-suite facilities.
· If en-suite facilities are not available, dedicate toilet or commode for patient/residents’ sole use.
· Place a notice on the room door advising staff of precautions required and for visitors to report to staff-in-charge before entering.
3. Limit patient/resident movement to other departments to essential visits that cannot be deferred.
Prior to patient/resident transfer
· Inform transport personnel (e.g. porters, EMT) and the receiving department/healthcare facility of the need for Contact Precautions.
· After patient/resident contact remove contaminated aprons/gowns and gloves, dispose and perform hand hygiene using soap and water, prior to transporting patient/residents.
· Don apron/gown and gloves prior to handling the patient/resident at the transport destination.
· Transport equipment (stretcher, bed, wheelchair) used for the transfer must be cleaned and disinfected before use with another patient/resident.
4. Wash hands before and after each patient/resident contact and contact with the patient/ resident‘s equipment or environment.
· Hands should be washed with soap (antimicrobial or non-antimicrobial) and water only. Alcohol alone is not effective, against C. difficile spores. If a non-antimicrobial soap is used, after drying use an alcohol hand rub.
· Advise/assist patient/residents to thoroughly wash their hands after toileting and before meals.
· Advise visitors to thoroughly wash their hands on entering and leaving the room.
5. Wear gloves & aprons when entering a room for all interactions that may involve contact with the patient/resident or potentially contaminated areas in the patient/resident’s environment.
· Remove gloves and aprons immediately after contact with any infective material, before touching non-contaminated items and environmental surfaces and before leaving the patient/residents environment
· Wash hands as above immediately after glove removal
· Visitors do not need to wear gloves & aprons unless providing personal care.
6. Dedicate equipment (e.g. hoist slings, thermometers, sphygmomanometers, stethoscopes,
glucometers) to single patient/resident use and use disposable materials whenever possible.
· Remove the commode from the room to dispose of contents and to clean and disinfect before returning commode to the room.
· Equipment which is shared e.g. hoist, shower chair, must be cleaned and then disinfected immediately after use with a chlorine releasing agent at a concentration of at least 1,000 parts-per-million (ppm) available chlorine (1,000ppm av cl),
· Only take essential equipment and supplies into the room. Do not stockpile.
· Patient/resident charts/records should not be taken into the room.
7. Thoroughly clean the patient/resident environment and all patient/resident care equipment daily using disposable cloths and a neutral detergent. Then, disinfect with a chlorine releasing agent at a concentration of at least 1,000 parts-per-million (ppm) available chlorine (1,000ppm av cl), paying special attention to frequently touched sites and equipment close to the patient/resident.
· Clean and disinfect immediately items likely to be faecally contaminated e.g. the under surfaces and hand contact surfaces of commodes.
· No additional measures are required for cutlery and crockery washed in a dishwasher.
8. Change linen daily. All laundry should be carefully placed in an alginate stitched or water
soluble bag and then placed into a laundry bag clearly identified with labels, colour-coded or other methods prior to transport to an approved laundry capable of dealing with contaminated linen.
· Avoid bringing into the room patient/resident’s personal clothing that cannot withstand a hot wash e.g. wool cardigans.
9. Dispose of waste contaminated with diarrhoea as healthcare risk waste e.g. incontinence wear.
· Dispose of non-contaminated waste as non-risk waste e.g. papers, etc.
Medication and Monitoring
10. Anti-diarrhoea medication should not be prescribed as this may prolong the period of infectivity.
11. Monitor & record colour, frequency and consistency of stool on a stool chart using the Bristol stool chart. Inform Medical Staff if patient/resident not improving.
12. Monitor fluid intake and output & observe for signs of dehydration.
13. Advice on appropriate antibiotic therapy should be sought from the Consultant Microbiologist.
14. When Contact Precautions are discontinued cleaning and disinfection of the environment must occur.
14b. Prior to initiating environmental cleaning and disinfection, all privacy, shower and window curtains must be removed and sent for laundering.
14c. All disposable items including paper towels, toilet paper, sterile and non-sterile supplies must be discarded.
14d. Send the patient/resident’s clothing for laundering e.g. dressing gowns, soft slippers, blankets etc.

Please sign and date for each shift to document compliance with care plan

Date/Time / Number / Complied with Care Plan/Change in Care & Progress / Signature