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Our hospital protocol states that if a patient has a new onset of greater than three loose watery stools within a twenty-four-hour time period that a stool specimen should be collected and sent for testing of Clostridium difficile. There is greater concern for those patients who also complain of abdominal pain and are accompanied by fevers, leukocytosis, anorexia, perforation or toxic megacolon, and neutropenic enterocolitis. Also, a positive assay test for C. diff that has reported high sensitivity are of concern as well. It is important to properly identify those patients who are suffering from Clostridium difficile for two reasons. First, once the person is identified as having C. diff we need to treat them and prevent further spread of the infection to other patients, visitors, and workers within the hospital or other health care facility. Second, we must be sure to verify the C. diff infection before initiating treatment so that we do not misuse antibiotics and create antibiotic resistance.
Antimicrobial resistance is defined as “resistance of a microorganism to an antimicrobial medicine to which it was originally sensitive to.” The nurse’s role in the antimicrobial stewardship is monitor that the antimicrobial guidelines in place are evidenced-based and reviewed or updated regularly, review and provide feedback of the hospital’s antibiotic data with focus on use of broad-spectrum antibiotics, and identify any non-compliance with the “guidelines, and general antimicrobial stewardship issues and other prescribing issues” such as duration of treatment, route of administration, and timing of the antimicrobial administration (Proquest, 2013). I honestly do not know all the details of my hospital’s antibiotic stewardship program, but I do know that it involves our infectious disease doctor, PharmD, and our infectious disease nurse at the very least and that our protocols are up to date and based on the latest evidenced-based practice.
One of the latest non-antibiotic interventions for clostridium difficile is the use of probiotics with non-pathogenic microorganisms and several forms of immunotherapy. Use of probiotics would help neutralize the microflora in order to eradicate the C. Diff pathogens. Research is still fairly new and developing, but from the data gathered thus far the results look promising (US National Library of Medicine National Institutes of Health,2000).
Our hospital protocol states that if a patient has a new onset of greater than three loose watery stools within a twenty-four-hour time period that a stool specimen should be collected and sent for testing of Clostridium difficile.