How nurses have come close to eliminating C. difficile cases

A nurse re-education programme achieves a drastic reduction in C. difficile infection

Hospital staff in Warwickshire are hoping to achieve 1,000 days free from the presence of Clostridium difficile on their wards thanks to a nurse re-education campaign.

The Get Stool Smart programme, launched by the infection prevention and control team at University Hospitals Coventry and Warwickshire NHS Trust, has brought the average number of reported cases down from 12 a month to one.

The team recognised that nurses needed more training on how to prevent and treat the infection after a large number of stool samples were being inappropriately tested.

Allison Bradley, advanced nurse practitioner in infection prevention and control told a C. difficile conference in Birmingham: 'The team realised a lot of stool samples were being sent for C. diff testing from patients who had no symptoms except diarrhoea. It suggested to us nurses were seeing diarrhoea and automatically thinking it was C. difficile, when there are so many other reasons a patient could have diarrhoea.

'In one case, the medical notes clearly stated the patient had a stool the size of a watermelon impacted in the rectum, which was causing overflow, but this had clearly not been read by the nurse who sent the sample for C. diff testing.'

The team began its campaign on Valentines' Day with a poem: 'Roses are red, violets are blue, check the chart before sending the poo.' Charts for monitoring were supplied to each ward to ensure data could be collected. Individual targets were set based on past performance.

Nurses were reminded of WIPE (Wash hands, Isolate promptly, Prudent antibiotics, Environmental cleaning) and encouraged to use Twitter, with the hashtag #getstoolsmart, to spread the message.

Ms Bradley said: 'It gave staff ownership of the problem and if a case of C. diff did occur they felt gutted if it was attributed to their ward.'

Eight wards out of 38 hope to be able to celebrate 1,000 days without a C. difficile case in April, she added.

Conference delegates were told that despite an 80% reduction in the number of C. difficile cases nationally in the past decade, there was still work to do. Public Health England's lead on C. difficile, Professor Mark Wilcox urged all healthcare professionals to take responsibility for the issue. He encouraged nurses to use a checklist, developed by Public Health England, as part of the move away from a culture of blame towards a more consistent approach.

To view the checklist click here

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