Clostridioides (Clostridium) difficile Toolkit for Long-term Care Facilities

This toolkit for C. diff infection (CDI) prevention and management in long-term care facilities provides resources in six topic areas: prepare, detect, contain, clean, prevent, and educate.

On this page:
Prepare
Detect
Contain
Clean
Prevent
Educate

Prepare

• Clostridioides (Clostridium) difficile Background
  C. diff is a gram positive, anaerobic bacterium that is linked to 29,000 deaths per year.
• Make a Team
  Preventing and managing CDI requires coordination among many stakeholders. Having an interdisciplinary team facilitates a swift and thorough response.
• Example CDI Prevention and Control Policy (Word)
  Creating a comprehensive C. diff policy can help to prevent and control cases. This is an example policy that long-term care facilities can customize.
• CDI Response Algorithm (PDF)
  Use this algorithm to enact a proper rapid response to a potential C. diff infection.

Detect

• Detection and Surveillance Self-Assessment (PDF)
  Early and accurate detection of CDI is critical for treating the resident, as well as preventing other residents from getting ill. Long-term care facilities can identify strengths and weaknesses in their C. diff detection and surveillance practices using this self-assessment.
• Clostridioides (Clostridium) difficile Algorithms for Long-term Care:
  Early Recognition and Testing Algorithm (A1) (PDF)
  Follow this algorithm to know when to test for C. diff and how to respond to the results.
• Clostridioides (Clostridium) difficile Surveillance
  Routine C. diff surveillance establishes baseline levels of C. diff, which helps to alert the facility when a possible outbreak is happening. Learn more about how to conduct C. diff surveillance.
• Clostridioides (Clostridium) difficile Testing
  Multiple laboratory tests can diagnose C. diff. These tests differ in turn-around time and accuracy. Learn the benefits and weaknesses of each test.
• Bristol Stool Chart; National Institute for Health and Clinical Excellence
  Only unformed stools, Type 5-7 on the Bristol Stool Chart, should be tested for C. diff. Refer to this chart to determine which stools should be tested.
• Tracking Tools; Quality Improvement Organizations
  The National Nursing Home Quality Improvement (NNHQI) Campaign provides an infection tracking tool with instructions to help track CDI in your facility.

Contain

• Clostridioides (Clostridium) difficile Algorithms for Long-term Care:
  Contact Precautions Algorithm (A2) (PDF)
  Residents with confirmed C. diff infection should be put on modified contact precautions. Follow this algorithm to know what precautions are needed.
• Hand Hygiene
  • Hand Hygiene Assessment (PDF)
    Long-term care facilities can compare their hand hygiene practices to best practices using this self-assessment.
  • Hand Hygiene for Health Professionals
    Thoroughly washing hands is one of the best ways to prevent C. diff transmission. These guidelines describe best handwashing practices.
  • Hand Hygiene Posters and Print Materials
    Display these materials to remind residents, visitors, and staff to wash their hands.
• Transmission-Based Precautions Door Signage
  Door signage informs family, staff, and other residents of necessary precautions when entering a room of someone with C. diff.
• Personal Protective Equipment (PPE)
  • Personal Protective Equipment (PPE) Assessment (PDF)
    Long-term care facilities can compare their personal protective equipment practices to best practices using this self-assessment.
  • Personal Protective Equipment Recommendations
    Properly wearing PPE decreases the risk of C. diff transmission. Follow these guidelines for how to select, don, and doff PPE.
• Clostridioides (Clostridium) difficile Transmission-based Precautions Audit Tool for Infection Prevention and Control (PDF)
  Learn what transmission-based precautions should be used when being exposed to a C. diff positive resident.
• Isolation Precautions in LTCF for CDI
  Learn what isolation precautions to use in order to limit other residents and staff from being exposed to CDI.
• Clostridioides (Clostridium) difficile Algorithms for Long-term Care:
  Room Placement Algorithm (A3) (PDF)
  This algorithm guides long-term care facilities on where residents with active CDI should be roomed and with whom.
• Infection Prevention and Control Isolation Compliance Checklist (Word)
  Long-term care facilities can use this checklist to audit their isolation precautions.
• Social and Activity Precautions
  Social and activity precautions decrease other residents' risk of contracting CDI. View an algorithm which can guide your facility.

Clean

• Environmental Cleaning Assessment (PDF)
  Long-term care facilities can use this assessment to see how their current activities compare to best practices.
• Clostridioides (Clostridium) difficile Algorithms for Long-term Care:
  Environmental Cleaning and Disinfection Algorithm (A4) (PDF)
  Use this algorithm to determine the proper cleaning method.
• Cleaning Recommendations for Prevention of Infectious Agent Transmission
  Learn the best methods for cleaning and disinfecting. Facility environmental cleaning policies should take into account that studies have shown shedding of C. diff bacteria up to six weeks after resolution of diarrhea.
• EPA: List K: EPA's Registered Antimicrobial Products Effective Against C. difficile Spores
  Because of the spore-forming nature of C. diff, only the products on this list are proven to remove the bacteria from surfaces.
• C. difficile Cleaning Audit Tool for Infection Prevention and Control (Word)
  This tool can be used for auditing cleaning in a long-term care facility.
• CDC Environmental Checklist for Monitoring Terminal Cleaning (PDF)
  A terminal cleaning must be done once a resident no longer has C. diff or is transferred out of their room. Use this checklist to ensure all areas are being cleaned properly.
• Environmental Hygiene Daily Resident Room Skills Checklist (Word)
  This checklist can be used to check compliance with environmental hygiene daily practices.

Prevent

• Current Prevention Activities Assessment (Word)
  Long-term care facilities can use this assessment to see how their current prevention activities compare to best practices.
• Minimum Criteria for Initiation of Antibiotics in Long-Term Care Residents (Loeb Criteria)
  The Loeb criteria guide providers' antibiotic prescribing practices in the long-term care environment.
• Antimicrobial Stewardship for Prevention of CDI
  Antimicrobial stewardship can improve the outcomes for residents who need antibiotics and prevent the unintended consequences of antibiotic use.
• CDI Treatment
  The proper treatment of C. diff can decrease the chance of recurrence.

Educate

• Current Education Activities Survey (PDF)
  Long-term care facilities can use this assessment to learn how their current education activities compare to best practices.
• CDC: C. diff: Facts for Clinicians
  Find answers to common C. diff questions.
• CDI Resident and Family Education
  C. diff precautions can be confusing for residents and their families and friends. Use this information to educate them about the infection.
• Employee Environmental Cleaning Education
  C. diff requires special cleaning practices in order to remove it from long-term care facilities. Educate staff with this tool.
• Additional Resources about C. diff Infection for Long-term Care Facilities
  Links and resources for LTCF about C. diff infection.