Higher Acuity – Is C. diff Allowed in a California RCFE?

Clostridium difficile (C. diff) is a bacterium that can cause symptoms that range from diarrhea to life-threatening inflammation of the colon.  Illness from C. diff is most common in older adults and typically occurs after use of antibiotic medications.

C. difficile is a spore-forming bacterium that spreads mainly on the hands from person to person, but can also be spread on bedside tables, toilets, sinks, thermometers, etc.

Community Care Licensing recently addressed the retention of residents with C. diff in their Summer 2013 Adult and Senior Care Update:

Colonized vs. Infected: What are the differences between C. difficile colonization and C. difficile infection?

C. difficile colonization:

  • Individual exhibits NO clinical symptoms
  • Individual tests positive for C. difficile organism and/or its toxin
  • More common than C. difficile infection

C. difficile infection:

  • Individual exhibits clinical symptoms
  • Individual tests positive for the C. difficile organism and/or its toxin

Colonization without infection is not prohibited in RCFEs. Thus, an exception is not required if a resident is colonized with C. difficile. However, the resident, the licensee and direct care staff should do the following: 1) follow any instructions from the resident’s physician or other appropriately skilled professional; and 2) practice universal precautions and any other precautions determined to be necessary by an appropriately skilled professional.

An exception is required to care for a resident who has a C. difficile infection. Regulation Section 87616, Exceptions for Health Conditions, allows a licensee to submit a written request to care for a resident with a prohibited health condition. An individual with a C. difficile infection may initially be treated in a hospital or skilled nursing facility. The licensing agency may receive a request to retain a resident with C. difficile infection when:

  • A resident has been or is being treated for C. difficile infection and still has diarrhea.
  • The resident’s physician or other appropriately skilled professional has determined that the resident does not need to be in a hospital or skilled nursing facility.
  • The licensee wishes to continue caring for the resident in the RCFE.

Click here for more information from CCL.

Click here to learn more about C. difficile from the Mayo Clinic.

2 Responses to “Higher Acuity – Is C. diff Allowed in a California RCFE?”

  1. Josh, this is a particularly helpful post. C-dif is one of those oft confused conditions. Your clarification between a colonized vs. active illness condition is helpful. We have had staff who, seeing D-dif on a hospital discharge to our community, over-react because they did not understand these differences. We now regularly instruct our direct care staffs using the kind of clarity your blog affords us.

  2. Thank you, Wade. Glad it is helpful!

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