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Clostridium Difficile Infection (CDI) (Nursing)

by Rhonda Lawes

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    00:01 Hi, and welcome to our video on superbugs.

    00:05 Okay. This is a huge problem in antibiotic treatments.

    00:09 So we'll talk about these superbugs as we discuss all the other antibiotic videos, but I want to take this one video just to really focus on the problem of super bugs.

    00:20 Now, what is a super bug? Because that might sound like a hero, but actually, it's a villain.

    00:25 These are bacteria that we used to be able to control with antibiotics, but now they're no longer sensitive to these antibiotics, and they're very, very difficult to treat.

    00:36 So these can make huge problems for your patient, and for you.

    00:40 So, let's take an example.

    00:42 Enterococcus used to be sensitive to vancomycin.

    00:46 Now, not any longer, It is resistant to vancomycin.

    00:50 So we call this superbug, instead of just enterococcus, now we call it vancomycin-resistant enterococcus or VRE because that is a mouthful to say.

    01:02 So I want to talk to you about some superbugs today, so you can be aware of what they are, how we treat them, and then we're going to talk about how not to develop more super bugs.

    01:13 Now, we want to know who's at risk for these crazy bugs.

    01:17 Usually, it's hospitalized patients. Now, think about that.

    01:20 Take a minute and think before you read your notes, why would hospitalized patients be more at risk to develop these superbugs? Okay, now, let's come back and talk about that.

    01:36 Hospitalized patients have lots of multiple problems, right? They wouldn't be in the hospital unless they weren't already not feeling great.

    01:44 So, usually their immune systems are under attack for one reason or another.

    01:48 So they've got higher odds of contracting a superbug because of that.

    01:52 So they're already in a something of an immunocompromised state.

    01:56 It's the place where we give a lot of these drugs that can cause superbugs, and they've probably dealt with a surgery or they have IVs or catheters.

    02:05 And what that means is, we've broken their host defenses.

    02:09 If you have a catheter, that's like a escalator right up into your UTI tract for bugs to go.

    02:16 If you have an IV, we've broken the skin.

    02:19 That's like a, "Hey, guys. Come on in," kind of moment, if you have an IV.

    02:23 Also surgery, you're doing the same thing.

    02:25 When you cut through that skin and that tissue, you're really at an increased risk for infection.

    02:30 So these are the types of people that are likely to be on antibiotics.

    02:33 These are the people that are likely to have been some type of compromise to their body, and they have a weakened immune systems.

    02:40 So, the reason that hospitalized patients are at higher odds is because they might be immunocompromised or have weakened immune systems, they're having antibiotics with treatment, and we've done something to them while they're in the hospital that put them at risk.

    02:56 We've started an IV, we've put in an IV catheter, or we've done surgery.

    03:01 So, already, I want you to start thinking about everyone you interact with in the hospital, not as being super contagious, but as being someone who is at definite risk.

    03:10 That's why we've worked really hard in the recent years to minimize the use of catheters, like for urinary drainage.

    03:17 We've tried to minimize that use because we know how risky and dangerous it is.

    03:22 Now, it's not the most convenient for the patient, and it does put us at some extra concern helping patients in and out of bed, help them use the restroom, but in the long run, it's much better for everyone.

    03:34 Okay, let's talk about C. difficile infection.

    03:38 Hey, it almost sounds sophisticated till you know what we're dealing with.

    03:43 It is the most common infectious cause of nosocomial diarrhea.

    03:49 And I wish -- you know like on cooking shows, they always say, "Mm, I wish you could smell this food." Well, I wish I could just give you some smell-o-vision for this CDI, because it is phenomenal. It will get stuck in your nasal passages, and you'll wish you could get that smell to go away.

    04:07 The diarrhea is also problematic to deal with, but this is all caused by a gram-positive anaerobic bacillus.

    04:16 Now, you see that in the picture.

    04:17 We know that it's gram-positive because it stains purple, and you can see that we've got a purple picture for you.

    04:24 And it is a bacillus because that's the shape of the bug.

    04:28 So when you're looking at your culture and sensitivity reports, you'll see those words on your report and you'll know what that means.

    04:36 Remember, gram-positive is supposed to be easier to treat, but once it's become a superbug or a resistant bug, it's no longer easier to treat.

    04:46 This becomes extremely difficult to treat.

    04:49 Now, some of this stuff is going to be very frightening for you as we talk about it because one of our normal host defenses is gastric acid should take care of bugs.

    04:59 Nope, not C. diff.

    05:01 It can survive gastric acid and then start to infect the bowel, and that's why you end up with this horrible diarrhea.

    05:10 Because these bugs, they can secrete toxins that causes diarrhea and this Pseudomembranous colitis.

    05:17 That's where you get the horrible smell that comes with it.

    05:22 So, normally, we used to be able to treat these bugs with antibiotic or maybe they'd be knocked out by our gastric acid, but not the superbugs.

    05:31 They can survive the stomach, make it into the gut, and then they start wreaking havoc by secreting these toxins that caused that horrible diarrhea, and that Pseudomembranous colitis.

    05:41 So this is the part that can keep me up at night.

    05:45 In fact, when I had to be in the hospital, I kept looking at my bedrails thinking, "Oh, oh, oh, what is growing on here? What's on my table?" I was probably the only person in the hospital that was wiping down her own surfaces because I just would overthink all the things.

    06:00 I had too much time to worry when I was in the hospital.

    06:04 These spores, these C. diff spores can stay on hard surfaces for weeks, okay? That freaked me out when I were thinking about that in the hospital.

    06:16 It should be a good reminder for you how important it is for us to take extra precautions with all our patients with contact.

    06:24 So, spores can stay on hard surfaces. That could be a bed rail, that could be the bedside table. That could be the floor.

    06:33 And these spores are present in stool.

    06:36 So because these patients deal with this horrible diarrhea, it's very easy for them to spread stool in places that you wouldn't necessarily expect.

    06:45 So when you're caring for a patient with C. diff, you want to be extra careful in how you clean both the patient -- make sure they're comfortable and their skin is well and intact-- and you also want to be careful that you're very careful in the environment to keep things super clean.

    07:01 I had a friend whose mother developed C. diff when she was at home, and they had to totally turn their house upside down.

    07:07 They only had her use 1 bathroom and 1 area just to try to limit that, and they were successful. No one in the house caught C. diff, but they had to be very strict with how they handled that.

    07:18 Now, I want to talk to you about the symptoms, the causes, and the treatment. I've told you enough about the scary stuff, but let's kind of break this down into those 3 categories.

    07:28 You kind of keep this in mind when you're thinking about Clostridium difficile infection.

    07:33 Okay, so the symptoms they can be -- we call them relatively mild, but if you're having diarrhea 10 to 20 times a day, I would think that's going to be life altering.

    07:43 But it can be GI distress, that really foul smelling diarrhea we've talked about, but it can also lead to really more severe ramifications.

    07:53 Because this could lead -- C. diff infection could actually lead to a sepsis that leads to death.

    07:59 So this actually can be life threatening.

    08:02 That does not mean that everyone who gets C. diff is going to develop sepsis, but it is a risk factor, so keep that in mind. You always want to take -- you always want to remember this is a serious issue, and we have to do everything we can to try to treat it quickly and efficiently.

    08:19 So the symptoms can be GI distress, pretty nasty diarrhea, all the way to the severe form that leads to sepsis and death.

    08:28 Well, what causes this? Like, who's most likely? We talked, in the beginning, that usually, it's hospitalized patients.

    08:35 But usually, it's patients that have had a bacterial infection and we treated it with a broad- spectrum antibiotic that kind of messed with their normal gut flora.

    08:44 Remember, that's how resistance happens.

    08:47 A broad-spectrum antibiotic --Look, they've got a great picture for you there.

    08:51 See how they have the different shapes of bacteria? That's to remind you and reinforce that concept of broad-spectrum antibiotics. They go after lots of different kinds of bacteria.

    09:03 Remember, you have good bacteria in your gut, and when we give you a broad spectrum antibiotic, we knock out those good bacteria.

    09:12 When we knock out those good bacteria, too, in addition to try and deal with an infection, now the bad bugs, the superbugs have more resources available to them and sometimes, they flourish.

    09:24 So, that's why you think of a patient who's most likely had a bacterial infection that we treated with a broad- spectrum antibiotic.

    09:32 Even if that was the most appropriate choice, it puts them at risk for developing something like C. diff.

    09:39 So, we've got some examples listed for you there at the bottom.

    09:42 Those are some of the broad- spectrum antibiotics that we really watch a patient closely for after for C diff.

    09:49 So, clindamycin, cephalosporins, ampicillin, amoxicillin, and the fluoroquinolones are ones that we know, patients might be at an increased risk to develop C. diff.

    09:59 Okay, so we've talked about the symptoms, you know, from mild GI distress to severe diarrhea to sepsis.

    10:05 We've talked about the causes.

    10:07 They've likely been treated for a recent bacterial infection with a broad-spectrum antibiotic.

    10:13 And I've given you some examples of some of those antibiotics to keep in mind.

    10:16 So, what do we do to treat this? Well, once C. diff has been diagnosed -- and you know how we do that, right? We'll have to actually take a sample of the diarrhea stool, send it down to lab, they will culture it.

    10:30 And obviously, they'll do a culture and a sensitivity on that stool sample.

    10:35 So, once we know that we have C. diff, we'll stop the antibiotic. If they're still on that antibiotic, we'll stop the antibiotic that caused that overgrowth and start a 2 different choices of antibiotics.

    10:47 So, remember, though, this can develop even after antibiotic usage has stopped.

    10:52 So, if the patient develops this C. diff, we want to make sure if they're still on that antibiotic that we started.

    10:59 And I've got 2 options there for you to use, or to consider for treating C. diff.

    11:05 So make sure you underline both of those medications because that's really important for you to remember.

    11:11 Now, we'll decide between those 2 medications -- and you see them on your screen -- based on the severity of the symptoms and lab work.

    11:19 So, it's not just a, "Oh, we'll always use this drug," or, "We'll always use that drug." The issue is we got to look at that culture and sensitivity and see how severe the symptoms are, and then we'll make the best choice for that particular patient.


    About the Lecture

    The lecture Clostridium Difficile Infection (CDI) (Nursing) by Rhonda Lawes is from the course Anti-Infective Drugs in Nursing.


    Included Quiz Questions

    1. A client admitted to the hospital for 3 weeks
    2. A client taking oral antibiotics at home
    3. A client working in a paint factory
    4. A client working in the fields
    1. Recent surgery
    2. Chronic antibiotic use
    3. Weak immune system
    4. Placement of an indwelling catheter
    5. Prolonged immobility
    1. Clostridium difficile
    2. Helicobacter pylori
    3. Vibrio cholerae
    4. Rickettsia
    1. Sepsis
    2. Anaphylactic shock
    3. Intestinal bleeding
    4. Respiratory depression
    1. Stop the antibiotic that caused the condition.
    2. Monitor hourly intake and output.
    3. Check vital signs every 15 minutes.
    4. Start clindamycin as soon as possible.

    Author of lecture Clostridium Difficile Infection (CDI) (Nursing)

     Rhonda Lawes

    Rhonda Lawes


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