Clostridium Difficile information

A suggestion for a C-diff nursing risk assessment and prevention tool

There are many nursing tools for assessing risks within the clinical setting; pressure ulcer risk assessments, falls risk assessments and nutritional screening tools. Posted here is my suggestion for a c-diff "at risk" assessment tool which could be helpful in detecting patients who are at risk of developing c-diff upon admission. I have also provided a suggested list of actions to be taken based on the "at risk" score of the patient which I think would also help in reducing incidents of cross infection. Note: This tool would need expert review and adjustment in order to be implemented.

Age	Score	Medication	Score	Medical Condition	Score	Gut Function	Score	Length of time in Healthcare environment	Score
14-29	0		0		0	Normal gut function (formed stools)	0	> 1 Week	0
30-49	1		1		1	Loose stools	1	<1 Week and less than 2 weeks	1
50-64	2	Any Antibiotics other than broad spectrum	2	Patients with a moderately compromised immune system eg. Post minor gastrointestinal surgery	2	Mild diarrhoea >4 stools per day (Liquid)	2	<2Weeks and less than 3 weeks	2
<65	3	Broad spectrum antibiotics Or immunosupressing drugs	3	Patients with a severely compromised immune system eg. Neutrophenics Severe infection/ post major gastrointestinal surgery or transplant or previous infection of c-difficile	3	Chronic diarrhoea <4 stools per day (Liquid/Blood /mucoid)	3	3 weeks and <3weeks	3
Total

Score:

Score	Action
0-5 = Low Risk	Advise patient to inform nursing staff of any changes in faeces.
5-10 = Moderate Risk	Send stool sample to microbiology as a precaution commence stool monitoring chart, reassess if necessary
10-15 = High Risk	Send 3 stool samples at different times during day, barrier nurse patient as a precaution and commence patient on (yakult) pro-biotic drinks. Alert medical staff and commence stool monitoring chart. Omit antibiotics until further notice