DEPARTMENT OF NURSING SCIENCES,

FACULTY OF HEALTH SCIENCES AND TECHNOLOGY,

COLLEGE OF HEALTH SCIENCES, NNEWI,
NNAMDI AZIKIWE UNIVERSITY.

NSC 332
MEDICAL SURGICAL NURSING

GROUP 2
TRACTION
NURSING MANAGEMENT, NURSING PROCESS, CARE PLAN, COMPLICATIONS

MRS AFONNE

SEPTEMBER 2024
GROUP MEMBERS

2021634011 Sule Josephine Onyemowo

2021634012 Chigbata Ifunanya Edna
2021634013 Okpala Christabel Adaeze
2021634014 Anyanwu Judith Uchechi
2021634015 Enemali Faith Nkechinyere
2021634016 Chukwudi Cynthia Makuochukwu
2021634017 Udogu Judith Chinelo
2021634018 Chinaza Blessing Enendu
2021634019 Igube Gloria Chinecherem
2021634020 Ewuzie chioma chelsea

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Clostridium difficile colitis results from disruption of normal, healthy bacteria in the colon,
often as a result of antibiotics. C. difficile can also be transmitted from person to person by
spores. It can cause severe damage to the colon and even be fatal.

Clostridioides difficile (klos-TRID-e-oi-deez dif-uh-SEEL) is a bacterium that causes an

infection of the colon, the longest part of the large intestine. Symptoms can range from
diarrhea to life-threatening damage to the colon. The bacterium is often called C. difficile or
C. diff.

Illness from C. difficile often occurs after using antibiotic medicines. It mostly affects older
adults in hospitals or in long-term care settings. People not in care settings or hospitals also
can get C. difficile infection. Some strains of the bacterium that can cause serious infections
are more likely to affect younger people.

The bacterium used to be called Clostridium (klos-TRID-e-um) difficile.

Symptoms
Symptoms often begin within 5 to 10 days after starting an antibiotic. But symptoms can
occur as soon as the first day or up to three months later.

Mild to moderate infection

The most common symptoms of mild to moderate C. difficile infection are:

Watery diarrhea three or more times a day for more than one day.
Mild belly cramping and tenderness.

Severe infection
People who have a severe C. difficile infection tend to lose too much bodily fluid, a condition
called dehydration. They might need to be treated in a hospital for dehydration. C. difficile
infection can cause the colon to become inflamed. It sometimes can form patches of raw
tissue that can bleed or make pus. Symptoms of severe infection include:
Watery diarrhea as often as 10 to 15 times a day.
Belly cramping and pain, which may be severe.
Fast heart rate.
Loss of fluids, called dehydration.
Fever.
Nausea.
Increased white blood cell count.
Kidney failure.
Loss of appetite.
Swollen belly.
Weight loss.
Blood or pus in the stool.

C. difficile infection that is severe and sudden can cause the colon to become inflamed and
get larger, called toxic megacolon. And it can cause a condition called sepsis where the
body's response to an infection damages its own tissues. People who have toxic megacolon

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or sepsis are admitted to an intensive care unit in the hospital. But toxic megacolon and
sepsis aren't common with a C. difficile infection.

When to see a doctor

Some people have loose stools during or shortly after antibiotic therapy. This may be caused
by C. difficile infection. Make a health care appointment if you have:
Three or more watery stools a day.
Symptoms lasting more than two days.
A new fever.
Severe belly pain or cramping.
Blood in your stool.

Causes
Colon and rectum
Colon and rectum
Enlarge image
C. difficile bacteria enter the body through the mouth. They can begin reproducing in the
small intestine. When they reach the part of the large intestine, called the colon, the bacteria
can release toxins that damage tissues. These toxins destroy cells and cause watery
diarrhea.

Outside the colon, the bacteria aren't active. They can live for a long time in places such as:
Human or animal feces.
Surfaces in a room.
Unwashed hands.
Soil.
Water.
Food, including meat.

When bacteria once again find their way into a person's digestive system, they become
active again and cause infection. Because C. difficile can live outside the body, the bacteria
spread easily. Not washing hands or cleaning well make it easy to spread the bacteria.

Some people carry C. difficile bacteria in their intestines but never get sick from it. These
people are carriers of the bacteria. They can spread infections without being sick.

Risk factors
People who have no known risk factors have gotten sick from C. difficile. But certain factors
increase the risk.

Taking antibiotics or other medicines

The intestines house a wide range of bacteria. Many of them help protect the body from
infection. Antibiotics that treat an infection tend to destroy some of the helpful bacteria in the
body as well as the bacteria causing the infection.

Without enough helpful bacteria to keep it in check, C. difficile can grow out of control
quickly. Any antibiotic can cause C. difficile infection. But the antibiotics that most often lead
to C. difficile infection include:

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Clindamycin.
Cephalosporins.
Penicillins.
Fluoroquinolones.

Taking a proton pump inhibitor, a type of medicine used to cut stomach acid, also may
increase the risk of C. difficile infection.

Staying in a health care setting

Most C. difficile infections occur in people who are in or have recently been in health care
settings. These include hospitals, nursing homes and long-term care facilities. These are
places where germs spread easily, antibiotic use is common and people's health puts them
at high risk of getting an infection. In hospitals and nursing homes, C. difficile spreads on:
Hands.
Cart handles.
Bedrails.
Bedside tables.
Toilets and sinks.
Stethoscopes, thermometers or other medical tools.
Telephones.
Remote controls.
Having a serious illness or medical procedure

Certain medical conditions or procedures can up the risk of getting a C. difficile infection,
including:
Inflammatory bowel disease.
Weakened immune system from a medical condition or treatment such as chemotherapy.
Chronic kidney disease.
Procedures on the digestive tract.
Other surgery of the stomach area.

Other risk factors

Older age is a risk factor. In one study, the risk of becoming infected with C. difficile was 10
times greater for people age 65 and older compared with younger people.

Having one C. difficile infection increases the chance of having another one. The risk
increases with each infection.

Complications
Complications of C. difficile infection include:
Loss of fluids, called dehydration. Severe diarrhea can lead to a serious loss of fluids and
minerals called electrolytes. This makes it hard for the body to work as it should. It can
cause blood pressure to drop so low as to be dangerous.
Kidney failure. In some cases, dehydration can occur so quickly that the kidneys stop
working, called kidney failure.
Toxic megacolon. In this rare condition, the colon can't get rid of gas and stool. This causes
it to enlarge, called megacolon. Untreated, the colon can burst.

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Bacteria also may enter the bloodstream. Toxic megacolon may be fatal. It needs
emergency surgery.

A hole in the large intestine, called bowel perforation. This rare condition results from
damage to the lining of the colon or occurs after toxic megacolon. Bacteria spilling from the
colon into the hollow space in the middle of the body, called the abdominal cavity, can lead
to a life-threatening infection called peritonitis.
Death. Serious C. difficile infection can quickly become fatal if not treated promptly. Rarely,
death can occur with mild to moderate infection.

Prevention
To protect against C. difficile, don't take antibiotics unless you need them. Sometimes, you
may get a prescription for antibiotics to treat conditions not caused by bacteria, such as viral
illnesses. Antibiotics don't help infections caused by viruses.

If you need an antibiotic, ask if you can get a prescription for a medicine that you take for a
shorter time or is a narrow-spectrum antibiotic. Narrow-spectrum antibiotics target a limited
number of bacteria types. They're less likely to affect healthy bacteria.

To help prevent the spread of C. difficile, hospitals and other health care settings follow strict
rules to control infections. If you have a loved one in a hospital or nursing home, follow the
rules. Ask questions if you see caregivers or other people not following the rules.

Measures to prevent C. difficile include:

Hand-washing. Health care workers should make sure their hands are clean before and after
treating each person in their care. For a C. difficile outbreak, using soap and warm water is
better for cleaning hands. Alcohol-based hand sanitizers don't destroy C. difficile spores.

Visitors to health care facilities also should wash their hands with soap and warm water
before and after leaving rooms or using the bathroom.

Contact precautions. People who are hospitalized with C. difficile infection have a private
room or share a room with someone who has the same illness. Hospital staff and visitors
wear disposable gloves and isolation gowns while in the room.
Thorough cleaning. In any health care setting, all surfaces should be carefully disinfected
with a product that has chlorine bleach. C. difficile spores can survive cleaning products that
don't have bleach.

C. diff is a germ (bacterium) that causes diarrhea and colitis (an inflammation of the colon)
and can be life-threatening.
C. diff can affect anyone. Most cases of C. diff occur when you've been taking antibiotics for
something else or not long after you've finished.
Talk with a healthcare professional about your risk for developing C. diff.
What it is

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Clostridioides difficile [klos–TRID–e–OY-dees dif–uh–SEEL], formerly known as Clostridium
difficile and often called C. difficile or C. diff., is a germ (bacterium) that causes diarrhea and
colitis. Colitis is an inflammation of the colon.

By the numbers
- C. diff is estimated to cause almost half a million infections in the United States each year.
- About 1 in 6 patients who get C. diff will get it again in the subsequent 2-8 weeks.
- One in 11 people over age 65 diagnosed with a healthcare-associated C. diff infection die
within one month.

Symptoms
Diarrhea
Fever
Stomach tenderness or pain
Loss of appetite
Nausea
Complications
Common complications
Dehydration
Inflammation of the colon, known as colitis
Rare complications
Serious intestinal condition, such as toxic megacolon
Sepsis, the body's extreme response to an infection
Death

People at risk
C. diff can affect anyone, but most cases occur when someone is taking antibiotics for
something else or not long after they have finished. People are 7 to 10 times more likely to
get C. diff while on antibiotics and during the month after.

That's because antibiotics that fight bacterial infections by killing bad germs can also kill the
good germs. These good germs protect the body against harmful infections, like C. diff
infection. If you take antibiotics for more than a week, you could be even more at risk.

Other C. diff risk factors include:

Older age (65 or older)
Recent stay at a hospital or nursing home
A weakened immune system, such as organ transplant patients taking immunosuppressive
drugs or people with HIV/AIDS or cancer
Previous infection with C. diff or known exposure to the germs
You can still get C. diff even if you have none of these risk factors.

C. diff is more common in healthcare settings, such as hospitals and nursing homes. This is
because many people carrying C. diff stay or get treated in those facilities.

Causes and spread

C. diff germs spread from person to person in poop (stool), but the bacteria are often found
in the environment.

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When C. diff germs are outside the body, they become spores. These spores are an inactive
form of the germ and have a protective coating allowing them to live for months or years on
surfaces and in the soil. The germs become active again when you swallow these spores
and they reach the intestines.

Healthy people don't get infected often even if the spores reach their intestines. If your
immune system is weak or you've recently taken antibiotics, you could get sick. Taking
antibiotics can affect your microbiome, making you more susceptible to illnesses like C. diff.

The microbiome
The microbiome is the collection of good and bad germs that live in your stomach and
intestines, your mouth, your urinary tract and on your skin. Some of those germs can cause
illness, but others are very important in keeping you healthy. A healthy microbiome helps
protect you from infection.

Antibiotics disrupt your microbiome, wiping out both the bad and the good germs that protect
the body against harmful infections, like C. diff infection. The effect of antibiotics can last as
long as several months. If you come in contact with C. diff germs during this time, you can
get sick.

Prevention
Reduce the spread of C. diff by washing your hands with soap and water after using the
bathroom and always before you eat. You can take steps to reduce your risk of C. diff.

Diagnosis
If a healthcare professional suspects C. diff, they will review your symptoms and order a lab
test of a stool (poop) sample.

Developing diarrhea is common while on or after taking antibiotics. Only in a few cases is
that diarrhea caused by C. diff. If your diarrhea is severe, do not delay getting medical care.

If you have been taking antibiotics recently and have symptoms of C. diff, contact a
healthcare professional.

Treatment and recovery

Treatment for C. diff usually involves taking a specific antibiotic such as vancomycin or
fidaxomicin for at least 10 days.
If you were taking an antibiotic for another infection, the healthcare professional might ask
you to stop taking it if they think it's safe to do so.
The healthcare team might admit you to the hospital. In this case, they will use certain
precautions, like wearing gowns and gloves to prevent the spread of C. diff to themselves
and other patients.
Some people get C. diff over and over again.

*Introduction*

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Clostridium difficile (C. difficile) is a Gram-positive, anaerobic bacterium that causes
diarrhea, colitis, and life-threatening complications, particularly in hospitalized patients and
those with compromised immune systems.

*Epidemiology*

C. difficile infections (CDI) are a leading cause of healthcare-associated infections (HAIs)

worldwide.

- According to the CDC (2020), CDI affects over 500,000 people annually in the United
States, resulting in approximately 29,000 deaths.
- A study published in The Lancet Infectious Diseases (2020) reported a CDI incidence rate
of 4.4 per 1,000 hospital admissions in the United States.

*Risk Factors*

1. Antibiotic use
2. Advanced age
3. Comorbidities (e.g., cancer, diabetes)
4. Immunocompromised status
5. Hospitalization and exposure to contaminated environments

*Symptoms*

1. Diarrhea (watery or bloody)

2. Abdominal pain and cramping
3. Fever
4. Nausea and vomiting
5. Life-threatening complications (e.g., toxic megacolon, sepsis)

*Diagnosis*

1. Stool tests (e.g., PCR, toxin assays)

2. Colonoscopy
3. Imaging studies (e.g., CT scans)

*Treatment*

1. Metronidazole or vancomycin for mild to moderate CDI

2. Fidaxomycin or bezlotoxumab for severe CDI
3. Fecal microbiota transplantation (FMT) for recurrent CDI

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*Prevention*

1. Antibiotic stewardship
2. Enhanced infection control practices
3. Environmental cleaning and disinfection
4. Hand hygiene

*Recent Research and Developments (2019-2024)*

1. A study published in the New England Journal of Medicine (2020) demonstrated the
efficacy of bezlotoxumab in reducing recurrent CDI.
2. Research in the Journal of Clinical Infectious Diseases (2022) highlighted the potential of
FMT in treating recurrent CDI.
3. A review in Clinical Microbiology Reviews (2022) discussed the emergence of
hypervirulent C. difficile strains.

*Conclusion*

C. difficile infections pose a significant threat to public health, particularly in healthcare

settings. Understanding risk factors, symptoms, and prevention strategies is crucial for
controlling the spread of CDI.

*References*

1. CDC. (2020). Clostridioides difficile Infection.

2. Lancet Infect Dis. (2020). Burden of Clostridioides difficile infection in the United States.
3. NEJM. (2020). Bezlotoxumab for Prevention of Recurrent Clostridioides difficile Infection.
4. J Clin Infect Dis. (2022). Fecal Microbiota Transplantation for Recurrent Clostridioides
difficile Infection.
5. Clin Microbiol Rev. (2022). Hypervirulent Clostridioides difficile Strains.

*Complications*

1. Toxic megacolon: Life-threatening condition requiring emergency surgery.

2. Sepsis: Bacterial infection in the bloodstream.
3. Colonic perforation: Hole in the colon wall.
4. Recurrent CDI: Infection recurrence after treatment.

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*Transmission*

1. Contaminated surfaces and equipment.

2. Healthcare worker transmission.
3. Patient-to-patient transmission.

*Prevention Strategies*

1. Antibiotic stewardship.
2. Enhanced infection control practices.
3. Environmental cleaning and disinfection.
4. Hand hygiene.
5. Isolation precautions.

*Treatment Options*

1. Metronidazole (Flagyl).
2. Vancomycin (Vancocin).
3. Fidaxomycin (Dificid).
4. Bezlotoxumab (Zinplava).
5. Fecal microbiota transplantation (FMT).

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