Introduction

The Centers for Disease Control and Prevention has classified clostridium difficile infection an urgent public threat (Weston, Burgess & Roberts, 2016).  Due to C. diff, there has been more than 400,000 infections and 29,000 cases of deaths in the USA in the year 2011 (Olson, Floyd, Howard, Hassanein, Warm & Oen, 2015). The findings in the presentation of C. diff infection include the presence of diarrhea described as passage three or more unformed stool in twenty-four or fewer hours. Similarly, it entails a positive stool test outcome or colonoscopic or histopathologic findings that demonstrate pseudomembranous colitis (Weston, Burgess & Roberts, 2016). In recent years, the healthcare sector has made significant efforts to combat the spread of C. diff infection including the use of probiotics. Besides, probiotics refers to live microorganism that when dispensed in adequate amounts would confer a health benefit on the host (Weston, Burgess & Roberts, 2016). Researchers have hypothesized that probiotic may effectively prevent and treat CDI through maintaining the normal gastrointestinal flora, completely inhibiting pathogens growth and secreting antimicrobial molecules.

Clinical Question

The following is the PICOT question that will be discussed. In hospitalized patients (P), how does probiotic (I), compared to absence of probiotic (C), reduce clostridium difficile infections (O)?

Background Summary

Clostridium difficile refers to the illness that develops due to the use of antibiotics in the health care setting. According to the report from the Center for Disease Control and Prevention, 25% to 30% of hospitalized patients will develop C. diff while on antibiotics (Olson, et al., 2015). The United States has a high number of antibiotic therapy; thus causing C. diff infections to rise at an alarming rate within the clinical setting.

Implications of C. diff infections may adversely affect the physiological health of an individual. Severe diarrhea caused by C. diff infections can make a person incontinent. According to Weston, Burgess & Roberts (2016), the patient’s quality of life would decrease due to the increased urgency and frequency of bowel movements. Moreover, CDI may cause the patient to experience an increase in pressure ulcers. The combination of the patient’s inability to bathe or transfer independently with increased incontinence and frequency of bowel movements is likely to increase the development of pressure ulcers in a patient. In addition, due to detrimental intestinal manifestation, mortality rates continue to rise steadily. Precisely, the elderly are at greater risk of infection and mortality from C. diff.

The financial implications of hospitalized patients with C. diff infection include high hospital costs and patient lengths of stay. Research shows that a patient who develops C. diff due to antibiotic therapy in a health care facility increases his stay in the hospital and incurs a cost of $10,000 per patient stay (Olson, et al., 2015). On average, a patient with C. diff will remain in the hospital four days longer compared to those with a similar problem. Therefore, due to high hospital costs and rates of patients infected with C. diff, healthcare facilities should consider the use of additional therapies to treat to solve this issue.

Regarding the emotional implication, isolated patients with a diagnosis of C. diff infection are prone to loneliness, low self-esteem and depression. Depressed patients will find it hard to interact with other people and might start thinking about bad things such as suicide. Some may feel stigmatized, and this may evoke rapid mood change, fear, and anxiety (Moyad & Hurlock, 2013). In addition, patients on contact precaution may feel that their dignity is affected since they rely on healthcare staff during this severe illness phase. Patients do not like it when they are unable to control their bowels; therefore, they feel helpless and embarrassed when nurses come to clean them up.

Diarrhea caused by C. diff infections affects different aspects of a person’s life experiences including the social functioning. Hospitalized patients with C. diff infections are often transferred to private rooms (Weston Burgess & Roberts, 2016). Isolation would have an adverse effect on the life of patients since they will miss familiar objects and routines such as family, friends and social events. The lack of energy, reduced appetite and fatigue will deteriorate lives of patients; thus depriving them of a healthy lifestyle with friends and family (Moyad & Hurlock, 2013).

The implications of patients with C. diff infections on the healthcare organizations include increased costs. Healthcare organizations are required to place hospitalized patients on contact precaution; however, in situations when there are inadequate private rooms, nurses would take additional time and resources to identify suitable transfer locations. Similarly, they will require additional time to carry out non-discharge terminal cleaning and intake assessment as they prepare to transfer patients to different units (Weston, Burgess & Roberts, 2016). The healthcare organization will incur extra costs because patients with a diagnosis of CDI will transmit C. diff within the clinical setting and this will increase other patients’ risk of developing CDI.

Purpose Statement

The purpose of this Evidence-Based Practice brief is to compare probiotic to the absence of probiotic as an effective treatment option for antibiotic-associated C. diff infections.

References

Moyad, M. A., & Hurlock, H. (2013). The supplement handbook. New York: Rodale.

Olson, B., Floyd, R. A., Howard, J., Hassanein, T., Warm, K., & Oen, R. (2015). A multipronged approach to decrease the risk of Clostridium difficile infection at a community hospital and long-term care facility. JCOM, 22(9), 398-406.

Weston, D., Burgess, A., & Roberts, S. (2016). Infection prevention and control at a glance. Hoboken, NJ: John Wiley & Sons.

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