Evidence-Based Practice: Managing Clostridium Difficile Infection

Between 2000 and 2005, the incidence of hospitalizations for Clostridium difficile infection (CDI) nearly doubled. So did the fatality rate from this infection. Risk factors for CDI (such as the use of certain antibiotics and gastric acid suppressors, age over 65, and hospitalization) are so common that CDI poses a continuing danger.

To help reduce that danger, recent research has identified ways for you and your colleagues to prevent and manage CDI, including these evidence-based guidelines:


  • Perform a complete physical examination and medical history review, including recent travel, surgery, hospitalization, antibiotic and other medication use, normal bowel pattern, and use of laxatives, stool softeners, or enemas.
  • Auscultate bowel sounds. Palpate for abdominal distention and tenderness.
  • Assess hemodynamic status, including vital signs, blood pressure, peripheral pulses, and capillary refill time.
  • Assess for diarrhea, noting stool frequency, estimated volume, and characteristics, such as color. Also assess for abdominal cramps, pain, and fever.
  • Assess for indications of CDI complications, such as bowel perforation, dehydration, metabolic acidosis, and systemic toxicity.
  • As ordered, collect a stool sample for enzyme immunoassay-based (EIA) glutamine dehydrogenase screening and a confirmatory assay for C. difficile toxins A and B. 
  • Monitor for an increased white blood cell count and decreased serum albumin level, which indicates worsening CDI. 
  • Prepare the patient with severe CDI for computed tomography of the abdomen and pelvis, as ordered, to assess for complications, such as ileus and obstruction.
  • Prepare for endoscopy, as ordered, particularly if the patient has severe colitis of unknown cause.

Planning and Implementation:

  • Implement isolation precautions for patients with diarrhea and risk factors for CDI, according to facility policy.
  • Maintain NPO status, as ordered, in the acute phase of the disorder. 
  • Restart meals with small amounts of bland, low-residue foods. Avoid coffee and tea, which are gastric stimulants.
  • Replace fluid and electrolytes, as prescribed, and maintain accurate intake and output records.
  • Teach the patient about perianal skin care, including the use of premoistened wipes and pH-balanced cleansers. Use a moisture-barrier ointment, if needed.
  • Administer vancomycin, metronidazole, and nonopioid analgesics, as prescribed.
  • Teach the patient and family about infection control measures (especially hand hygiene), the disease, and the antimicrobial regimen.
  • Advise the patient and caregiver to call the physician if CDI signs or symptoms recur.


By discharge, the patient should:

  • Have a bowel pattern that returns to baseline within 7 days.
  • Be free from fever and abdominal pain within 7 days.
  • Display no signs or symptoms of complications.
  • Have fluid and electrolyte balance restored.

For more information on managing CDI, see Evidence-Based Nursing Monographs: Clostridium Difficile in Mosby’s Nursing Consult

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