NOSOCOMIAL GASTROINTESTINAL INFECTIONS

Clostridium difficile and rotaviruses remain the most common recognized causes of nosocomial diarrhea. Nosocomial diarrhea predisposes to nosocomial infections. Stool softeners and antacids are risk factors associated with C. difficile carriage, while older age, severe underlying disease, antibiotics, gastrointestinal stimulants, stool softeners, and enemas are risk factors related to C. difficile diarrhea. C. difficile-colonized patients may be a source for infections in other hospitalized patients. Vinyl gloves can decrease hand carriage and transmission of C. difficile. Excretion of the organisms or cytotoxin may occur even after treatment and clinical response. Nosocomial rotavirus spread in children is related to infected roommates and hospital staff with contaminated hands. Using the proved effective disinfectants and educating staff and parents of the need for and techniques of handwashing are important. Routine stool culture and ova and parasite examination are inappropriate for most patients with nosocomial diarrhea. Helicobacter pylori, Yersinia enterocolitica, Shigella sonnei, and Cryptosporidium parvum are additional etiologies sometimes seen in nosocomial diarrhea. Irrespective of the cause, all hospitalized patients with diarrhea should be promptly placed in enteric precaution to prevent spread of fecal organisms to other hospitalized patients.