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C - Diff in assisted living residence


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Old 09-29-2013, 09:56 AM   #1
Older student
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C - Diff in assisted living residence

I just learned confidentially from a care manager in my mother's Asst Living residence that another resident who is on hospice has C Diff. The aide was concerned that this resident is not quarantined and that no one has been notified of it. She felt obligated to tell me. I am concerned as my mother just returned from the hospital after being treated for a UTI and is on antibiotics. Does anyone know what the common practice is? I understand HIPAA privacy rules prohibit information being released, but isn't this a public health requirement? I am trying to decide how to inquire without violating the confidential nature that this info was given to me. Has anyone experienced this issue with an assisted living residence. Thanks.

 
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Old 09-29-2013, 07:54 PM   #2
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Re: C - Diff in assisted living residence

I do not think C-Diff is something that qualifies under quarantine. It is caused by a bacteria that is actually present everywhere, and even in some healthy people. C-diff spores are difficult to destroy and live for years. In healthy individuals, who are not on antibiotics, there are good bacteria and our immune system that will handle the bad bacteria. When there is an imbalance of bacteria you can get C-diff. It is probably not contracted from another person but from spores that are ever present. Most often this happens when somebody is on antibiotics or has a weakened digestive/immune system. The main way this bacteria is transmitted is through feces so it is imperative that the staff use proper hygiene. Yes, they should use good old soap and hot water instead of hand sanitizers since the alcohol based liquids are ineffective against c-diff and other infectious agents as well. Gloves should be used and disposed properly between each patient. With appropriate hygiene, which should always be used, the likely hood of transmission minimal. It is not a reason for concern since it is easily contained. I am sure the care giver was concerned but it is not as contagious as she thinks and can be easily handled with proper care

There were a few cases of C-diff in Mom's facility. One here and there but never a cluster of cases.

Love, deb

 
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Old 09-30-2013, 05:54 AM   #3
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Re: C - Diff in assisted living residence

In nursing homes and hospitals a stool sample positive for c. diff requires contact isolation for the patient. However, an assisted living is not a nursing home or a hospital. So the rules, depending on the state, can vary widely, even within the assisted living (different rules for different wings - memory care, etc.). Student, I would take your concerns to your director of facility and ask what its policy is for infectious residents and see what the answer is.

The other problem is that yes, aide/care manager violated HIPAA. She is not the resident's doctor and only the doctor knows whether the patient is still contagious (again would be determined by a stool sample) and therefore even if you should be concerned.

And I echo Deb's thoughts about good hygiene, esp for yourself while you are visiting. It is very contagious, a friend of mine caught it while taking her husband to the ER for something else (not c. diff). She was very sick, we though she was going to have to go to hospital.

 
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Old 09-30-2013, 08:38 AM   #4
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Re: C - Diff in assisted living residence

Backseat is right that the rules are different for Hospitals, nursing homes, and assisted living facilities. Here, only if there are a certain number of cases of an infectious disease do the assisted living does have to notify the CDC. At that point the CDC decides on the need for quarantine. We went through this last winter with the NoroVirus. With C-Diff, which is a bit more difficult to spread than an air born virus, you rarely get these clusters. Contact isolation of one patient can be done without difficulty, if the staff is aware and follow protocol and appropriate hygiene, without disrupting the facility activities. One of the problems is that many assisted living facilities are not as proactive as the more acute care facilities when it comes to medical issues.... and there is very little regulation.

There is also a lack of understanding. Not all diarrhea is C-diff and not every loose stool is diarrhea. I was told by several aids that Mom had C-diff when in fact she was having one or two loose stools a day caused by Ensure. When I talked to the nurse, we figured it out quickly. We did a stool sample just to be on the safe side and it came back negative. So be a bit leery of what you are being told in confidence. As Backseat said....talk to the Admin or the nurse and see what is really going on.

Love, deb

 
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Old 10-24-2013, 03:25 AM   #5
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Re: C - Diff in assisted living residence

It absolutely requires contact precautions at a hospital or nursing home. As others have said, assisted living can be different. If she doesn't have caretakers constantly in and out of her room all day every day and everyone is washing their hands well (sanitizer doesn't kill C-diff) including her, she should be OK. The caregivers for the person with C-Diff will be diligent in not spreading it, because they know the person has it and are probably taking precautions not to spread it. The person who has it likely won't venture out of his/her area too much because they won't be able to be far from a bathroom

 
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Old 10-29-2013, 10:00 PM   #6
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Re: C - Diff in assisted living residence

Just now seeing this... My mother is in a new nursing facility, and is doing SO much better! In the previous nursing home, she had C-Diff a total of 4 times in just over a year! One bout of it lasted for 3 months! Yes, they should be quarantined. In a place like a nursing home, it is easily spread. The CNA's and Nurses MUST use gloves, gowns, etc.. and when you see her/him, you must also. If you should leave the room, you must take off the items, and when you come back in, you must put on new ones. It is a hard infection to fight, a nasty bug. They have to do cultures and see 'where' it is in her/his body. Bad thing about it is (especially for women), the powerful antibiotics can cause an array of other problems as it fights off the infections.

Be diligent in having your loved one tested when protocol calls for it! Push the issue! I learned that after 2 weeks of the special type of antibiotic, they were to test her, then if the first round of antibiotics didn't work, they would go to phase 2 with a different kind of antibiotic.

Hope all is well... just now saw this posted!
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