title: How is diarrhoea managed in UK care homes? A survey with implications for recognition and control of Clostridium difficile infection.
abstract: BACKGROUND
  Policy and regulatory efforts to reduce Clostridium difficile infection (CDI) rates now focus increasingly on the community setting, especially residential and nursing homes for the elderly. We aimed to describe how potentially infectious diarrhoea is managed in care homes, and to explore related infection control and human waste management practices.
  
  
  METHODS
  A questionnaire was sent to all care homes in Sussex, asking about management of diarrhoea and related infection control practices.
  
  
  RESULTS
  Response rate was 41%. Residents with diarrhoea were reported to be isolated promptly in 36% of homes, and 78.2% of homes reported always wearing appropriate personal protective equipment. Most homes waited over 24 h before sending stool samples for testing. Human waste was disposed of by automated sluice in only 26% of care homes. Bedpans were washed in residents' sinks in 20.7% of residential homes, and in communal baths in 9.6%.
  
  
  CONCLUSIONS
  This study shows that most care homes are not fully compliant with current infection prevention and control guidance, and that some unacceptable practices are occurring. In order to reduce potential for transmission of CDI and other diarrhoeal infection in care homes, infection prevention and control practices must be improved, with early diagnosis and control.
authors.affiliation: Division of Primary Care and Public Health, Brighton and Sussex Medical School, Falmer, Sussex BN1 9PX, UK.
authors.forename: Hazel J
authors.initials: HJ
authors.lastname: Henderson
authors.forename: Liz
authors.initials: L
authors.lastname: Maddock
authors.forename: Sue
authors.initials: S
authors.lastname: Andrews
authors.forename: Peter
authors.initials: P
authors.lastname: Trail
authors.forename: Nancy
authors.initials: N
authors.lastname: Loades
authors.forename: Bernadette
authors.initials: B
authors.lastname: Purcell
authors.forename: Angela
authors.initials: A
authors.lastname: Iversen
authors.forename: Martin J
authors.initials: MJ
authors.lastname: Llewelyn
authors.forename: Jackie A
authors.initials: JA
authors.lastname: Cassell
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016360:Clostridioides difficile / Q000302:isolation & purification*; D003967:Diarrhea / Q000175:diagnosis*; D004761:Enterocolitis, Pseudomembranous / Q000517:prevention & control*; D019538:Health Care Surveys; D006707:Homes for the Aged; D006801:Humans; D017053:Infection Control / Q000379:methods*; D006113:United Kingdom