C-Diff and Mrsa

Germs such as bacteria, viruses, and fungi cause infections when they enter the body of an individual. Well known examples include methicillin resistant staphylococcus aureus (MRSA) and clostridium difficile. The role of hospitals in relation to infection is important. Alderson & Roberts (2000) established the principle that "hospitals should do the sick no harm". Today the NMC (2008) requires nurses to work with others for protecting and promoting the health and wellbeing of those in their care, their families and carers, and the wider community. Consequently nurses and students need to know the infection control procedures in their practice area.

It has been estimated that 8-10 per cent of patients may acquire a hospital-acquired infection during their stay. The cost to the NHS is at least £1 billion per annum. Hospital acquired (nosocomial) infections delay patient recovery extend the period of hospitalization, and increase pain, discomfort, anxiety and stress levels. They thereby impact on patients and their families and increase health service costs. The Department of Health (2003) acknowledges that healthcare-acquired infections cannot be completely eliminated, but estimates that about one third may be prevented through effective measures. MRSA has become endemic in some hospitals and some senior nurses have suggested that it is out of control. A prospective microbiological study of MRSA contamination in isolation rooms following the discharge of a MRSA positive patient, found that daily routine cleaning over a four week period did not remove MRSA contamination. Inadequate cleaning and therefore the removal of exogenous MRSA predisposes to cross-infection with MRSA, so once a patient is discharged, the ward must be cleaned thoroughly before the next patient is admitted.

The transfer of patients with MRSA should be kept to a minimum. The receiving hospital or ward should be given due notification of the patient's arrival, so that the necessary preparation can be made (such as a side room and equipment for the patient). Ambulance and portering staff should also be notified in order to ensure that the ambulance, chair, or bed used to transfer the patient is cleaned before it is used again.

Clostridiuim difficile is a slender, gram positive anaerobic rod which is spore forming and motile: it is widely distributed in soil and the intestinal tract of animals. It can cause foul smelling diarrhoea, abdominal pain and fever. It is found in carpets, blood pressure cuffs, thermometers, nurses' uniforms, radiators, curtain rails, commodes, floors and toilets. The spores may be transferred when air is disturbed, for example when windows are open or floors are cleaned. Clostridium difficile is a common cause of mortality and morbidity in hospitalized patients and has increased in the past several years.

The risk of cross-infection can be reduced by:

* restricting the use of antibiotics that encourage the growth of clostridium difficile

* reducing the duration of antibiotics being administered

* reducing the length of hospitalization

* careful hand washing

* environmental decontamination

* isolating patients.

Washing hands with detergent and water, drying them carefully and finally cleansing with alcohol hand rub is also required, while cleaning the environment with hypochlorite also reduces the incidence of Clostridiuim difficile. Infection control must be a priority for nurses across all areas of healthcare, whether in hospital, community, nursing or residential homes. This helps to ensure a safe and clean working environment for staff to work in, ensure that patients receive optimal care and promote health and well-being.

Clostridium difficile infections are most commonly associated with patients in hospital who have been given broad-spectrum antibiotic therapy. These antibiotics inactivate other competing bacteria, which normally live in the gut and inhibit the germination of C. difficile spores. The resulting suppression of the normal gut flora makes these patients more vulnerable to C. difficile infection. A further risk factor is increasing age: the elderly (>65 years) are much more susceptible to C. difficile infection and over 800 of reported infections occur in this age group. The organism also causes disease in animals, most notably enteric disease in piglets although it has also been implicated as the agent causing diarrhoea in calves.

Transmission of C. difficile is normally considered to be by the faecal oral route, but there is a suggestion that C. difficile could also be a food-borne pathogen. This hypothesis is supported by a rise in infections amongst individual in non-healthcare settings (i.e., in the wider community), including the young as well as individuals who have not recently been taking antibiotics, and the results of recent studies identifying similarities between isolates from food animals, food, and humans. The severity of Clostridium difficile infections varies. In mild cases the infection causes non-blood diarrhoea and sometimes abdominal pain, nausea, vomiting, dehydration and low-grade fever. However, infections can be very severe causing ulceration and bleeding from the colon (colitis). This may result in perforation of the intestine leading to peritonitis, which can be fatal. When colitis is present reported death rates vary from 6 to 30%.

Cross infection with C. difficile is believed to be common and is compounded by widespread environmental contamination (20-70% of sample sites) which is especially pronounced if a patient has explosive diarrhoea. Clostridium Difficile is an infection on the rise in hospitals today. Nurses must be able to recognize patients who present with the common risk factors, such as above, the age of 65, on antibiotic therapy, have a history of bowel disease. All health providers clean their hands with soap and water before and after caring for a patient, we can prevent the spread of this infection. Wear appropriate personal protective equipment, and sterilize any equipment that the patient had come into contact with can lower that chance of transmitting this infectious disease.

Current national and local infection control policies state that measures must be taken to prevent infections from occurring in healthcare facilities so as to destroy or remove sources of pathogenic micro-organisms, thus protecting people from being infected and interrupting the transmission of pathogens. The NICE (2000) clinical guidelines on infection control policies should he followed for any care provided or received at home, in a clinic or health centre, or in the community. Community-acquired infections

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