SHEA GUIDELINES Bundle (free trial)

Table 3. Summary of Recommendations to Prevent CDI (cont'd) 3. Place patients with diarrhea on contact precautions while C. difficile testing is pending. (L) a. Place patients with new-onset, unexplained diarrhea on contact precautions. Employ measures (see Essential Practices), particularly use of gowns/gloves and disinfection of shared medical equipment. Initiate contact precautions as soon as diarrhea symptoms are recognized because this is the period of greatest C. difficile shedding and contamination. b. If there is limited availability of private rooms or ability to cohort patients in nonprivate rooms while testing is pending, the decision to place a patient on contact precautions in a private or cohort room may be based on several factors, including likelihood that patient will transmit C. difficile, turnaround time of CDI test results, and impact of contact precautions on hospital bed management. c. If C. difficile testing is negative, and another infectious etiolog y that requires contact precautions is not suspected, contact precautions may be discontinued based on test type and clinical suspicion for CDI. 4. Prolong the duration of contact precautions aer the patient becomes asymptomatic until hospital discharge. (L) a. CDC currently recommends contact precautions for patients with CDI for at least 48 hours after diarrhea resolves. Some hospitals may choose to extend contact precautions for the duration of hospitalization even if symptoms have resolved. b. Facilities must balance potential reduction in C. difficile transmission with individual patient risk of isolation related to contact precautions, which may include falls and socioemotional stress that can lead to symptoms such as behavior changes, anxiety, depression, and anger. 5. Use an EPA-approved sporicidal disinfectant, such as diluted (1:10) sodium hypochlorite, for environmental cleaning/disinfection. Implement a system to coordinate with environmental services if sodium hypochlorite is needed for environmental disinfection. (L) a. Sporicidal disinfectants registered with the EPA, including sodium hypochlorite, can be found in the EPA List K. b. Data have not been consistent regarding the ability of sporicidal disinfectants, including diluted sodium hypochlorite, to control CDI through environmental decontamination. c. When an EPA-approved sporicidal disinfectant is instituted for environmental decontamination, it is necessary to coordinate activities with environmental services. d. When using diluted (1:10) sodium hypochlorite, address several issues including : measures to avoid toxicity to patients and staff, removal of organic matter from surfaces before use, and use of freshly diluted or appropriately stored diluted sodium hypochlorite. e. When a sporicidal method will be used only in rooms of patients with CDI, create a system to identify these patients to environmental service staff.

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