Prevent the Spread of C. Diff on Oncology Units


Repeated education and other protocols can decrease the spread of this deadly infection.

Hospital-acquired infections can negatively affect outcomes in patients with cancer, so it is imperative that oncology nurses are vigilant about preventing them. After seeing a spike in Clostridium difficile infection (C. diff) a few years ago, nurse researchers at City of Hope National Medical Center conducted a root-cause analysis and then created an intervention plan to stop the spread.

The results were presented by Karen Wohlgezogen, BSN, RN, CPHON, clinical nurse manager at City of Hope, during the 2020 ONS Bridge Virtual Conference.1

“C. diff is a spore-forming [bacterium] that is very resilient, and difficult to kill,” Wohlgezogen said. “It causes life-threatening diarrhea and colitis.”

In their initial analysis, the researchers realized that C. diff infections were occurring in adjacent rooms during the same time frame, which likely was a result of staff spreading the infection, Wohlgezogen explained, noting that some staff members were also unable to correctly answer questions about shared equipment being cleaned adequately. They also noticed family members of patients in isolation rooms not washing their hands when they left the room.

“Anytime you’re cleaning anything having to do with C. diff, you definitely have to use bleach, so it’ll kill the spores. Alcohol gel and alcohol wipes don’t do it,” Wohlgezogen said. “But we had complaints from staff, patients, and families about using bleach. They didn’t like the strong smell, it seemed to stain the clothes of the staff using it.”

Fixing the issue began with patient and staff education. In addition, nurses were in charge of getting patients and families any items they may have wanted or needed, such as coffee or snacks, so that they could be sure that things were cleaned appropriately before and after use.

Next, they realized the importance of patients bathing daily, either by shower or bath, to decrease the bacteria count on the body. Then the team identified that bedside commodes likely were not being cleaned as thoroughly as they should be—particularly the heavy-duty bucket underneath that catches the waste. Therefore, City of Hope started to use single-use patient items.

“Once we did the bedside commode buckets as a single-use, we definitely saw a decrease [in C. diff],” Wohlgezogen said.

When it came to vital sign machines, the team ensured that there were enough so that oncology patients in isolation could keep theirs in their room for the duration of the stay, and it would not have to be shared with other patients. Similarly, they made sure that the computers on wheels were also kept in isolation patients’ rooms, when possible.

“Our recommendation is to maintain a high focus on [C. diff] infection prevention, and that the education just continues with the nursing [and medical] staff, patient families, and all the people who touch the patients,” Wohlgezogen said.


Wohlgezogen K. Decreasing C.difficile Infection Rates: the Bundle Approach. Presented at: 2020 ONS Bridge Annual Conference Sept. 8, 10, 22, and 24, 2020. Accessed Sept.22, 2020.

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