Purpose: Clostridium Difficile (C. Diff), a spore-forming, gram-positive anaerobic bacillus producing exotoxins A and B, is associated with the development of severe diarrhea (CDAD). A virulent CDAD strain associated with up-regulation of both toxins has emerged with morbitity rates up to 16.7%¹. Sepsis, colon perforation, toxic megacolon and pseudomembranous colitis are associated morbidities. C. Diff spores can remain on inanimate objects for up to 70 days² and can be cultured on hands of healthcare personnel, making disease spread a constant threat. Irritant dermatitis causing perineal skin breakdown is a frequent sequelae of this bacterial disease.

Objective: Having immunoassay positive results for the virulent strain, this agency developed an algorithm to contain potentially infected fecal material based on patient continence and ADL status. The algorithm uses fecal containment* and fecal management devices** in a step-wise approach to maintain skin integrity and prevent the spread of potentially infectious fecal material based on patient ability to self-toilet, stool characteristic, skin integrity, presence of perineal dermatitis, surgical incisions or pressure ulcers.

Outcomes: Interventions to reduce the dispersal of potentially infected stool in incontinent patients are now rapidly initiated. No further incidences of virulent CDAD have been identified. Early intervention has reduced the incidence of perineal dermatitis and the loss of skin integrity. Wound care providers now have a viable option to manage skin integrity while simultaneously minimizing the spread of a potentially fatal bacterial disease.

¹ Loo VG, Poirier, L, Miller, M et al. A Predominantly Clonal Multi-Institutional Outbread of Clostridum difficile-Associated Diarrhea with High Morbidity and Mortality. N Engl J Med 2005;353:2442.

² http://healthlink.mcw.edu/article/954992292.html. Accessed October 7, 2006

*Flexi-Seal Fecal Collector, ConvaTec, a division of E.R. Squibb & Sons, L.L.C.

** Flexi-Seal Fecal Management System, ConvaTec, a Bristol-Myers Squibb Company, L.L.C.

Flexi-Seal is a registered trademark of E.R. Squibb & Sons, L.L.C.