Does working as a nurse increase my risk of Clostridioides difficile (C. difficile) recurrence?

Risk of C. difficile Recurrence for Nurses

Working as a nurse does not significantly increase your risk of C. difficile recurrence compared to the general population, but your occupational exposure to healthcare settings may be a contributing factor if proper infection control practices are not followed.

Risk Factors for C. difficile Recurrence

The primary risk factors for C. difficile recurrence include:

• Antibiotic exposure: The most important modifiable risk factor 1

  • Highest risk during and in the first month after antibiotic exposure (7-10 fold increase)
  • Risk extends up to 3 months following cessation of therapy
  • Higher risk with longer exposure and multiple antibiotics

• Patient-specific factors 1:

  • Advanced age (>65 years)
  • Underlying comorbidities
  • Immunodeficiency
  • Low vitamin D levels
  • Previous exposure to fluoroquinolones
  • Inflammatory bowel disease

• Medication-related factors:

  • Continuous use of proton pump inhibitors (50% increased risk) 1
  • Acid-suppressing medications (controversial, may be confounded) 1

• Healthcare exposure factors:

  • Prolonged hospital stays (>2 weeks) 1
  • Exposure to healthcare settings with C. difficile spores 1

Occupational Risk for Healthcare Workers

While the guidelines do not specifically identify nurses as having a higher risk of C. difficile recurrence, healthcare workers may have increased exposure to C. difficile spores in healthcare settings 1, 2. However, this exposure alone doesn't necessarily translate to higher recurrence rates if:

1. Proper infection control measures are followed
2. Hand hygiene with soap and water is practiced consistently 2
3. Contact precautions are observed when caring for patients with C. difficile 2

Prevention Strategies for Healthcare Workers

To minimize your risk of C. difficile recurrence as a nurse:

• Hand hygiene: Wash hands with soap and water rather than alcohol-based sanitizers when caring for patients with C. difficile, as alcohol does not effectively kill spores 2

• Personal protective equipment: Use gloves and gowns when entering rooms of patients with C. difficile 2

• Antibiotic stewardship: If you require antibiotics for any reason, discuss with your provider:

  • Using the narrowest spectrum antibiotic possible
  • Limiting duration of therapy
  • Avoiding high-risk antibiotics (fluoroquinolones, clindamycin, cephalosporins) when alternatives exist 1, 2

• Medication review: Consider discontinuing unnecessary PPIs if you're taking them 1, 2

When to Seek Medical Attention

If you've had C. difficile previously and develop recurrent symptoms:

• Diarrhea (≥3 loose stools in 24 hours)
• Abdominal pain or cramping
• Fever

Seek prompt medical attention, as early treatment can prevent complications and reduce the risk of subsequent recurrences.

Treatment Options for Recurrence

Current guidelines recommend:

• First recurrence: Oral vancomycin or fidaxomicin 2, 3
• Multiple recurrences: Consider fidaxomicin, bezlotoxumab (monoclonal antibody against C. difficile toxin B), or fecal microbiota transplantation 2, 3, 4

Remember that while your occupation may expose you to C. difficile more frequently, following proper infection control practices significantly reduces your risk of both initial infection and recurrence.