Utililizing Probiotics to Decrease the Risk of Antibiotic-Associated Diarrhea

The frequent use of broad spectrum antibiotics, such as Clindamycin, Cephalosporins and Fluoroquinolones (Xie et al., 2015) in hospitalized adult patients may increase the risk of developing Antibiotic-associated diarrhea (AAD). According to Jafarnejad et al.(2016), AAD occurs between 5%-39% among adult patients, and multiple studies have proven that probiotics can reduce the incidence of AAD. Currently there is no protocol in place at this acute care organization, so the purpose of this six-month study was to monitor the incidence of AAD in adult patients who received a probiotic drink. The PICOT question was created as follows: “ Over a six month period, in adult patients receiving antibiotic therapy on a medical surgical unit, does the consumption of a probiotic supplement reduce the incidence of antibiotic-associated diarrhea?”

Hospital infections related to AAD are far costlier than the daily cost of a probiotic drink (Vitko, Sekula & Schreiber, 2017). Prior to initiation of the study, a hospital based probiotic protocol was created. The chief clinical dietitian conducted daily huddles with the nursing staff on the specific unit. Once staff education was completed, all patients on receiving broad spectrum antibiotics were screened by a member of the dietitian/nutrition team for eligibility. Contraindications to receiving the drink included milk protein allergies, strict nothing by mouth (NPO) orders, clear liquid diets, neutrophil count < 100, patients who received transplants and those on high dose steroids. Eligible patients received the drink with their breakfast and lunch trays along with an education card briefly describing the probiotic drink. To monitor the consumption of the drink, the nursing assistants completed a monitoring log for both mealtimes. Elements on the log included percentage of drink consumed for meals, use of a laxative, community acquired clostridium difficile, and bowel prep orders. These logs were completed daily after breakfast and lunch, for all patients on the unit previously screened and eligible to consume the probiotic drink.

AAD may cause pressure injury and delay wound healing (Wong et al., 2015). Patients at risk may include those older than 65 years, have compromised immune systems, an ongoing illness, and use multiple medications (Xie et al., 2015). Jafarnejad et al., (2016) and Issa & Moucari (2014) placed a major emphasis on increase morbidity and mortality, length of stay and hospital costs because of AAD. These may influence extended hospital stays, readmissions, increases in hospital costs and a decrease in patient satisfaction / experience. These consequences are pertinent implications for nursing practice. To sustain this probiotic drink process as a practice, daily reminders were conducted to the staff during briefs and huddles. Ongoing patient education continues, while the nursing staff persistently encourage patients to consume of the drink.

At the end of six-months (February 2017 to August 2017), data showed that 446 separate patient visits received the probiotic drink at least once. 96% of those patients did not experience diarrhea; 2% of the sample had diarrhea related to laxative use, stomach cancer or community acquired Clostridium difficile (c-diff). There were zero cases of hospital acquired C-diff in the pilot unit. In the remaining 2% who had diarrhea, we speculate that it might have been attributed to AAD. Going forward, the initial pilot team plans to share best practice by replicating the program on another unit within the same organization, and sharing the results to local and national arenas.