Meeting the Quota on C.Diff

What is it with docs and ordering C.Diff?  Why is it that if a patient has diarrhea, the order a test for C.Diff?  Some days it feels like they went to an in-service recently and all remembered that C.Diff causes diarrhea and now anyone with loose stool should be checked -even if there are no other reasons besides loose stools.  Here are some great examples of stupid rule-outs for C.Diff.

Dude who has ruled out 5 times within the last 3 months, ruled out the previous week on Friday and now on Monday they decide think that he needs to be ruled out again.  Why?  His white count is up.  Did they forget that he has pretty much chronic aspiration pneumonia?  Guess what?  He ruled out a second time.

How about end-stage liver disease chick on lactulose?  We all know lactulose, right?  Binds to ammonia and flushes it out of the system – in the stool.  And it’s always diarrhea.  Never met a lactuloser with normal, non-runny poop.  “But by God, she might have C.Diff!  She has loose stools!” say the residents.  “What are you stupid?” say the nurses.  Guess who was right?

Or the LOL on tube feeds with no real gut flora anymore who has loose stools.  Or the liver resection dude that ruled out last week and evidently needs to be ruled out again.  Or the ICU transfer with colitis?  (OK, I’ll give ’em that one)  How about the LOL in with constipation who we give docusate, senna, biscoadyl, Miralax and MOM to so that they can poop, and when they do, thanks to all the loosening products that stool is nearly liquid?  They surely have the Diff, right?  Or my tried and true favorite, the patient who had 1 loose stool 5 days ago, and has yet to poop this admission.  They must have C.Diff.  But the patient so that is so bound up from narcs that they are pooping marbles, yes, the poop rattled in specimen cup just like a marble, pretty much takes the cake.

It almost like each resident group has a quota to fill for C.Diff rule-outs.  And even when presented with rational evidence like lactulose, multiple bowel care products, rules-outs less that 72 hours prior, they blunder on blustering about antibiotics and gut flora and elevated white counts and diarrhea.  Then they walk into the room without isolation gear on.  I don’t get it.


  1. Guaranteed that as soon as the order for a stool sample for C.Diff is ordered, the patient will stop having diarrhea.


  2. Face it 60 percent of the persons who go to the hospital get another free disease in Canada and yes thousands, many next do die from it.. Now it is not the patient’s deaths who disturb the doctors and nurse now.. they have grown cold and callous to it.. but they hate the people who shit in their bed.. it is a big dirty job to clean it up.. it is real work they do not like.


  3. How do I handle a patient on Lactulose and has C Diff. He has constant runny stools and cannot sleep due to evacuation on himself. Also, encephalopathy is prominent.
    He has:
    Liver disease
    Ongoing paracentesis
    Thank You


    1. I don’t dispense medical advice. You’re looking for a “fecal management system” Google it. Good luck.


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