Introduction: The incidence and severity of Clostridium
difficile infection (CDI) has been increasing and long-term care facility
(LTCF) residents are at high risk given their age, co-morbidities, and high
antibiotic exposure. Infection control policies are crucial for controlling
CDI, but there are currently no regulatory guidelines in the United States.
Therefore, we evaluated infection control policies in local LTCFs to define the
CDI-specific policies and the administrative and staff understanding of CDI, so
as to identify perceived barriers for compliance. Methods: IRB approval was
sought and exemption granted, all 8 local LTCFs were asked to participate. Each
facility was visited by study personnel who interviewed the administrative
Infection Control Practitioner (ICP) and 3-4 Licensed Practical Nurses (LPNs)
with distinct survey format. Infection control policies were then compared to
the SHEA recommendations for CDI in LTCFs. Results: Of the eligible facilities,
75% (n = 6) participated. ICP (n = 6) and LPNs (n = 21) were interviewed. All
facilities accept residents with active CDI and 2 had written CDI-specific
infection control policies. All facilities had hand hygiene or glove use
policies and 2 had policies for the use of sporicidal environmental cleaning.
No facility restricted antibiotic use. Each facility has a policy to instruct
their staff through in-services, either annually or upon new hire, but 33% (n =
7) LPNs reported no facility-based CDI training. While 80% (n = 17) of LPNs
felt comfortable with the facility CDI policies, only 11 accurately restated
it. ICPs felt the most relevant barrier to staff compliance was time
constraints (n = 4, 67%), however, LPNs felt it was limited knowledge (n = 10,
48%) and poor communication (n = 2, 10%). Discussion and Conclusions: With the
increasing incidence and severity of CDI in LCTF, few of the facilities
surveyed had CDI-specific policies. Despite CDI-specific training, there is a
perceived knowledge and communication gap for staff caring for residents with
CDI.