What is ‘Careful Observation’ and How Can it Improve Infection Prevention in Healthcare Settings?
“So another missed opportunity for doing better infection prevention with C. difficile
, relates to antibiotic use [by] the public. The public has a perception that antibiotics will make them feel better, which is not always the case. The public will often demand or request antibiotics for a viral infection and that won’t make them feel better physically, but it often makes [them] feel better psychologically, because now [they’ve] been given something by the doctor that makes us feel better. Having [an antibiotic] prescribed by the physician, there’s some weight to that, [which] we can’t [psychologically feel] when we [take medications] that come over the counter from the drugstore somehow.
I think we have to help educate the public about the differences between viruses and bacteria. We have to, all of us, not just patients, but all of us in healthcare as well, become more willing to delay starting an antibiotic [regimen] and engage in what some people have called 'watchful waiting'. I like to call [it] 'careful observation,' [because] when we say 'watchful waiting' it sounds like we’re not doing anything and that’s not the case, we actually are carefully observing people, and this is especially true for people who are in long-term care and post-acute care facilities.
Often it’s not clear if an older adult truly has an infection so if we can wait 6 hours, 12 hours, 24 hours [or] 48 hours before starting an antibiotic, and offer them more hydration, review their medicines, make sure they’ve gotten a good night’s sleep, talk to them and see what else might be going on, [then] there might not be a need for an antibiotic. That spares them the exposure to a potentially harmful medication, which is fantastic.”
How Can Healthcare Providers Improve C. diff Infection Control in Long-term Care Facilities?
ways that we can improve infection control of [Clostridium difficile
] C. diff
in long-term care facilities [is] to consider extending the isolation time. Some places have policies where once someone is continent of stool after 48 hours, they come out of contact precautions or isolation precautions. That may not be long enough. Sometimes the C. diff
will recur; that happens often among older adults, up to 30% of the time. By the time [this has] recurred they’ve become an infectious risk again and that poses a problem for everyone else in the facility.
What one facility in my area has done, with great success, is they keep a stool chart. They monitor for up to two weeks after someone has been off of therapy for C. difficile
how often [patients] are going to the bathroom, and if they see early signs of diarrhea, they [are put] right back on the contact precautions and they start thinking about [if] they need to reinitiate therapy for C. difficile
. They’ve had great success; I think it’s a fantastic and practical approach.
Another innovation from this particular facility is that they put all of their C. diff
patients or residents that are going to participate in rehab [and] they schedule those folks at the end of the day so that all [of] the equipment can be wiped down thoroughly with bleach and they don’t have to worry about getting the next person in. [Therefore], they can do a really thorough job and all [of] the equipment is clean and ready to go the next morning.”