Investigation of acute diarrhoea in care homes/ elderly
patients
For general advice on assessment of acute diarrhoea see clinical knowledge
summary:
http://www.cks.nhs.uk/diarrhoea_adults_assessment#-471656

Assess severity – ensure patient does not need hospital admission

Exclude other causes e.g. overflow, known sources of enteric infection,
laxatives, high energy feeds, known inflammatory bowel disease.

Suspect HCAI (C diff) if patient was inpatient at hospital or prescribed
antibiotics in preceding 8 weeks and falls into an at risk group eg elderly,
frail, prev C diff infection (toxin positive or negative), taking high dose
PPI, clinical contact of C diff (although person to person transmission is
unusual) . There are no clinical features to make a C diff infection more
likely.

Send stool spec for C diff testing if suspected.

DO NOT TEST FOR C DIFF WITHIN 3 MONTHS OF A POSITIVE
RESULT. The result will be positive anyway so treat if symptomatic
according to the advice of a consultant microbiologist.

Care homes should not be sending in specimens without having liaised
with the responsible primary care clinician.
Advice on the management of C diff will always accompany the positive
result. If in doubt ask the microbiologist.
Isolate suspected cases while awaiting a result.
Doldon
July 2012