2013 APIC Guide Expands C. difficile Prevention Efforts to Procedure and Outpatient Care Areas

The newly updated 2013 APIC “Guide to Preventing Clostridium difficile Infections” provides a valuable resource for healthcare professionals and facilities committed to reducing the prevalence of healthcare -associated infections (HAI’s).  Clostridium difficile infections (CDI) affect more than 7,000 inpatients on any given day (5 every minute), costing up to $51.5 million a day, or as high as $18.5 billion annually.  Factor in the mortality rates of up to 300 patients a day (1 every 5 minutes) in one study, and it is no surprise that C. difficile is increasingly referred to as one of the greatest infection control challenges facilities face today. 

The CDC estimates that 94% of C. difficile infections are connected to receiving medical care, including patients seen in hospitals, nursing homes, outpatient centers, and even office settings.  In response to the growing prevalence and risks associated with exposure to C. difficile, the recently updated APIC Guide includes the establishment of containment strategies in both inpatient and outpatient procedure areas (endoscopy, surgery, diagnostic labs, etc).  The implementation of processes to minimize transmission risks as patients are transported to or receive care in these areas include the following: 1) evaluation of patient flow and placement, 2) appropriate use of PPE, 3) enhanced observation of Contact Precautions (to include the use of disposable drapes to protect equipment surfaces from becoming contaminated during procedures), and 4) communication and education efforts regarding the risks of C. difficile.  This expanded focus highlights the critical need for the integration of comprehensive infection prevention protocols throughout the continuum of care as we continue to battle against this highly transmissible and potentially deadly pathogen.

In considering procedure areas and outpatient departments most likely to provide care to patients colonized or infected with C. difficile or other resistant GI pathogens, perhaps none stands out more than an endoscopy/GI lab.  (Table 1 provides an overview of some of the most common GI bacteria and microbiota, though this list is by no means exhaustive.)  Given the nature of the procedures performed in these departments (colonoscopy, sigmoidoscopy), encountering GI bacteria and secretions is not only possible, it is predictable.  Though often regarded as a “dirty, non-sterile procedure,” there (arguably) exists no other department or procedure performed where GI bacteria, secretions, or other potentially infectious materials (OPIM) are as predictably and repetitively encountered.  Colonoscopy or sigmoidoscopy procedures are often performed for the rapid diagnosis or confirmation of C. difficile or pseudomembraneous colitis (PMC) in addition to diagnostic or screening procedures, and can involve a wide demographic of both inpatients and outpatients. 

Endoscopy procedures, by operational definition, are not performed under the more stringent “aseptic” or “sterile field” techniques of a surgical procedure.  However, due to the predictability and nature of potential exposure and origin of pathogens, both Enteric and Contact Precautions should be implemented.    Such precautions should include the use of protective barriers to adequately cover (linens are not barriers) adjacent and high-touch surfaces (gurney, linens, and patient surfaces) that can be removed and disposed of prior to transport from the procedure room.  In the alternative, all exposed surfaces (gurney, frames, hand rails, patient) should be thoroughly cleaned and linens changed prior to moving the patient from the procedure room in order to contain and confine bacterial deposits, secretions, and OPIM.  Given the nature and predictability generating GI secretions and pathogens, containment efforts should be consistently implemented in order to reduce environmental loads and maintain safety for patient staff and a facility.

The ENDODRAPE Endoscopy Containment Systems provide a simple to use, cost effective solution in meeting the Enteric Contact Precautions necessary to contain pathogens, secretions, and OPIM during endoscopic procedures. The ENDODRAPE establishes the barrier protection for high-touch surfaces during the procedure, as recommended by CDC and Joint Commission guidelines. The effective containment of bacteria and secretions generated during these procedures is a critical first step in protecting your patients, staff, and facility from exposure to environmentally mediated GI pathogens.  This can become critically important as patients and gurneys are moved into the recovery area and gurneys used to transport patients to other areas of your facility following an endoscopy procedure.  By containing pathogens at the point of initial contact (or source), the ENDODRAPE provides a valuable tool for reducing risks of infections caused by cross transmission.  The ENDODRAPE promotes cleaner practices during procedures, improves procedural flow and equipment protection, and can substantially reduce procedure room turn-times when compared to the additional interim cleaning processes that would be required.

 For more information on this Best Practice in Infection Prevention and Control, please take just a few minutes to view our educational video at www.endodrape.com/video, or contact us by phone at 888-867-8351 or email at sales@vorteksurgical.com.