A Nurse’s Guide to C Diff Management

• Clostridium difficile infection (C Diff) causes colitis and diarrhea. As a nursing professional, learn the proper steps in C Diff management.   
• C Diff is commonly related to a patient’s current antibiotic treatment.  
• To begin C Diff management, nurses must consider subjective and objective data. 

Clostridium difficile infection, also known as C Diff, is a gram-positive, rod-shaped bacteria. The spores survive in unfavorable conditions and are easily transmitted through contact with objects and humans. C Diff infection causes colitis and diarrhea. This article aims to inform nurses about managing an active C Diff infection.   

Nursing Process for C Diff Management

Since C Diff infection is often related to a current antibiotic treatment that the patient is taking, it is critical to stop the antibiotic causing the infection and replace it with another medication that will be less likely to cause these bacteria. Surgery may be required in severe cases if the colon is damaged — supportive treatment through proper nutrition and adequate fluid intake as necessary to prevent dehydration. Nurses are vital in managing C Diff symptoms like diarrhea and abdominal pain. Nurses also instruct patients and staff on precautions to prevent the transmission of bacteria.  

Nursing assessment: The first step of nursing care is assessment. The nurse gathers physical, psychosocial, emotional, and diagnostic data.  

Subjective data: Note the patient’s general symptoms. Diarrhea and colon inflammation (colitis) are the hallmark signs of C Diff infection. Severe C Diff symptoms include: Dehydration, severe abdominal pain and cramping, watery diarrhea occurring more than 10 times per day, nausea, fever, swollen abdomen, weight loss, loss of appetite, kidney failure, and presence of blood or pus in the stool.  

Assess the patient’s bowel habits: Signs and symptoms of mild to moderate C Diff include watery diarrhea more than three times per day, for more than one day, with mild abdominal tenderness and cramping.  

Ask the patient to recall the possible transmission: Interview the patient on any incidents in which they might have had contact with C Diff through the following: Food, water, soil, contaminated hands, human or animal feces, and dirty surfaces.

Contact tracing: C Diff is highly contagious and can easily be transmitted through person-to-person contact and contaminated items. Some patients carry bacteria (known as carriers) that can spread the infection to others. 

C Diff Risk Factors

Anyone can be infected by C Diff. These factors increase the risk of C Diff:  

• Recent use of antibiotics  
• 65 years old and above   
• Recent hospitalization or nursing institution admission  
• Compromised immune system  
• History of C Diff infection  
• Inflammatory bowel disease  
• Chronic kidney disease  
• Recent surgical procedure  

Review the history of antibiotic use. Antibiotic use is the most common cause of C Diff infection. Antibiotics like Clindamycin, penicillins, and cephalosporins tend to destroy healthy bacteria in the body, along with the bacteria they are created to kill. Without these helpful bacteria, C Diff can multiply and cause infection.  

C Diff Management

Physical assessment: Monitor the patient’s temperature. C Diff can trigger a fever as an immune response. A temperature of 100.4°F is frequently observed. 

Observe the stool characteristics. Frequent, foul-smelling, watery stools are typical in C Diff.   

Monitor the hydration status. Since C Diff causes severe diarrhea, there is a higher risk of dehydration. Monitor for signs and symptoms such as:  

• Fatigue  
• Headaches 
• Lightheadedness and dizziness 
• Dry mouth 
• Tachycardia 
• Low blood pressure 
• Loss of appetite 
• Nausea, vomiting, abdominal pain, and abdominal distention  
• Concentrated urine 
• Dry skin, decrease in skin moisture, and poor skin turgor 

 Watch out for signs of shock. Serious complications like severe dehydration can arise from diarrhea related to C Diff.  

It can result in the following:  

• Alteration in mentation l 
• Lethargy 
• Confusion 
• Rapid heartbeat
• Fainting 
• Electrolyte imbalances and hypotension 

 Diagnostic Procedures 

Obtain stool for testing: Patients should be evaluated for C Diff if they experience three or more loose, unformed stools of sudden onset in 24 hours without any other known cause. In severe colitis, stools may test positive for blood.  

Send blood samples for laboratory testing. A complete blood count may reflect increased white blood cells. Electrolyte and serum creatinine levels may show signs of dehydration, fluid accumulation in the tissue, and renal damage. Albumin levels are likely decreased in a C Diff patient. Serum lactate levels are increased in severe cases of C Diff. 

Assess for possible complications. If the healthcare provider suspects potential complications of C Diff, an abdominal X-ray or CT scan should be considered. 

Implement Contact Precautions: Patients with C Diff should be on contact precautions. Put the patient in an isolated room if diarrhea is present and advise the patient and visitors of the following:   

• Wash hands with soap and water after every restroom use.  
• Only use a private bathroom dedicated to the patient. 
• Never share utensils and personal things with others.  
• Clean room and surfaces with bleach disinfectants. 
• Strict implementation of contact precautions, including hand hygiene and wearing of gloves and a gown. 
• Hand sanitizer is not practical in killing C Diff spores. 

Manage diarrhea and complications by doing the following:

• Promote hydration. Fluid losses occur quickly with diarrhea.  
• Severe dehydration may need to be treated with IV therapy.  
• Encourage plenty of oral fluids as tolerated. 
• Hydration can also prevent kidney failure.  
• Rest the colon: During diarrhea, advise the patient to avoid certain foods, such as dairy products, fatty foods, foods high in fiber, and foods with seasonings.  
• Eat bland foods to help minimize stomach upset and irritation. The BRAT diet, which stands for bananas, rice, apples, and toast, can reduce diarrhea.  

Monitor the electrolytes: Replenish the electrolytes and fluid loss due to diarrhea. Diarrhea can be life-threatening due to dehydration and electrolyte imbalances.  

Encourage the patient to take probiotics as recommended: Supplements or foods containing microorganisms known as probiotics are meant to help the body’s healthy bacteria grow.  

Provide skin care: Frequent watery diarrhea irritates the perineal area and can cause skin breakdown, pressure ulcers, and other infections. The perineal areas should be kept clean, dry, and soothed with cool wipes. Apply barrier creams if the patient is incontinent.   

The Bottom Line

C Diff is a common infection; most are mild and short-lived, but others can be serious. As a nurse, you play a significant role in managing patients infected with C Diff. This includes taking all necessary precautions, managing symptoms, and monitoring for potential complications.   

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