title: Identification, optimal management, and infection control measures for Clostridium difficile-associated disease in long-term care.
abstract: Residents of long-term care facilities are at an increased risk of exposure to Clostridium difficile and become more susceptible to infection after receiving antimicrobial therapy. An increasing number and more severe cases of C. difficile-associated disease (CDAD) have been reported over the last few years and have been linked to the emergence of a new, more virulent strain of C. difficile. These serious cases of disease have also been associated with a more atypical clinical presentation and have prompted the need for an improved means of early recognition and identification performed by the nursing staff. This article reviews the pathogenesis and risk factors for CDAD, changing epidemiology of CDAD, and characteristics of the newly identified strain. Also reviewed are the role of nursing in the identification of patients with CDAD; optimal management of CDAD; infection control strategies; and education of health care professionals, residents, and visitors in the long-term care setting.
authors.affiliation: University of Virginia Health Systems, Charlottesville, Virginia, USA.
authors.forename: Kathleen Ryan
authors.initials: KR
authors.lastname: Fletcher
authors.forename: Marisa
authors.initials: M
authors.lastname: Cinalli
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D016360:Clostridioides difficile; D003015:Clostridium Infections / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D003428:Cross Infection / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D004196:Disease Outbreaks / Q000517:prevention & control / Q000706:statistics & numerical data; D042241:Early Diagnosis; D005544:Forecasting; D015577:Geriatric Assessment; D006801:Humans; D017053:Infection Control / Q000458:organization & administration*; D008134:Long-Term Care / Q000458:organization & administration*; D024802:Nurse's Role; D009730:Nursing Assessment; D009735:Nursing Homes / Q000458:organization & administration; D009740:Nursing Staff / Q000193:education / Q000458:organization & administration; D010353:Patient Education as Topic; D017410:Practice Guidelines as Topic; D012008:Recurrence; D012307:Risk Factors; D016635:Universal Precautions
chemical_list: D000900:Anti-Bacterial Agents