"Ask NE GAPNA Members" Question

Generally I think it is wise to start precautions in pts that are considered high risk: poor immune system, recent antibiotic treatment. Especially if they are incontinent and/or having a lot of diarrhea. While Metronidazole is the recommended first line for mild to moderate disease, I may avoid it in my very frail patients who may have poor appetites to begin with. I worry that they will totally stop eating. Here is a link to some CDC guidelines:http://www.cdc.gov/HAI/pdfs/cdiff/Cohen-IDSA-SHEA-CDI-guidelines-2010.pdf

Our SNF facility starts contact precautions the moment an order to obtain a stool sample for Cdiff is entered. Although I see how this is beneficial for protecting other patients and residents, it also secludes many patients when suspicion is low (recent antibiotic use, so need to rule it out, but also on multiple laxatives or other reasons to be having diarrhea). I also believe it may even prevent some providers from ordering stools and possibly even prevents nursing from reporting concern when Cdiff is a viable differential since they do not want to (or don't have time to) deal with all the work involved in changing patient rooms and initiating contact precautions. Understand that Metronidazole is still recommended first line, but we have had high resistant rates as well as intolerance, and I tend to just start with oral Vanco at this point.