At Grane Rx, we’re committed to providing the highest-quality LTC pharmacy services. As part of that commitment, we share an ongoing series of pharmacy updates from our Chief Clinical Officer, designed to keep you in the know on clinical topics related to long term care pharmacy and PACE pharmacy. Clostridium difficile, or C. diff, is a type of Gram-positive spore-forming bacteria that develops in about half a million people each year. C. diff infection is an extremely serious healthcare complication that can result in increased frailty, malnutrition, sepsis, pseudomembranous colitis and even death. C. diff is responsible for more than 10,000 deaths each year. Residents of a long term care facility are considered to be a vulnerable population due to close contact and constant exposure to bacteria; therefore, healthcare providers have a responsibility to ensure the safety of these residents while receiving care.
What Long term Care Pharmacy and Other Providers Should Know
What are the causes of C. diff? The residents who will be most likely to contract C. diff are the residents who:- Are taking proton pump inhibitors
- Are immunocompromised
- Have had gastrointestinal surgery
- Have come into contact with contaminated feces
- Have had antibiotic exposure
- Abdominal cramping
- Fever
- Peripheral leukocytosis/pseudomembranes seen on lower gastrointestinal endoscopy
- Nausea
- Loss of appetite
- Diarrhea (watery stool that occurs ≥3 times a day for at least 2 days)
- Keep hands clean and wash regularly. (Use soap and warm water. Alcohol does not kill C. difficile spores.)
- Identify residents who are suspected of having C. diff as early as possible.
- Implement contact precautions for residents who are suspected of having C. diff in order to prevent transmission.
- Assign residents who are infected to isolation.
- Maintain clean medical supplies and equipment.
Long term Care Pharmacy Treatment of C. diff
| Clinical Classification | Therapy | Duration |
| Simple | Metronidazole, 3x500mg orally | 10 days |
| Vancomycin, 4×125 (to 250)mg orally | 10 days | |
| Severe | Vancomycin, 4×125 (to 250)mg orally | 10 days |
| Severe, complicated | Vancomycin, 4×125 (to 500)mg orally | 10 days |
| (plus) metronidazole, 3x500mg IV | 10 days | |
| First recurrence | Vancomycin, 4×125 (to 250)mg orally | 10 days |
| Fidaxomicin, 2x200mg orally | 10 days | |
| Multiple recurrence | Vancomycin, 4x500mg orally (4 days), followed by stool transplantation in an experience facility | <7 days |
Elements of an Antibiotic Stewardship Program
Because of the potential impact of C. diff infection in the long term care population, many antibiotic stewardship programs are specifically focusing on managing C. diff. As a refresher, there are seven key components to antibiotic stewardship programs, which include:- Leadership commitment. Creating a culture which promotes antibiotic stewardship throughout the facility is a key starting point.
- Accountability. Empowering team members such as the medical director, director of nursing, consultant pharmacist and infection control team members to have ownership for antibiotic stewardship efforts.
- Medication Expertise. Tapping into available resources such as your consultant pharmacist and infectious disease consultants to assist in developing and supporting your program.
- Action. Creating and implementing necessary policies and procedures to support the antibiotic stewardship program.
- Tracking. Tracking the outcomes of all new interventions will enable the facility to determine successes and areas that may need additional attention.
- Reporting. Reporting will enable on-going analysis of program successes and outcomes while providing the team with information to identify potentially new areas of focus.
- Education. Engaging all parties, including residents, facility staff, prescribers and family members, will ensure optimal and continuous success of the program.
