Harmony Healthcare International (HHI) Blog

C-Diff and Isolation Blog 8.16.2022



Clostridium Difficile

“C Diff”

The most common question HHI receives related to isolation is whether a facility can code Isolation on a resident with a diagnosis C-Diff?

Hopefully, last week’s blog on isolation and the below information from the CDC will help answer this question. In summary, a facility can code isolation on a resident who is positive for C-Diff if the infection cannot be contained, and the parameters discussed on the preceding page are met.

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Per the CDC:


Clostridium Difficile: “C. diff” is a spore-forming, Gram-positive anaerobic bacillus that produces two exotoxins: toxin A and toxin B. It is a common cause of antibiotic-associated diarrhea (AAD) and accounts for 15 to 25% of all episodes of AAD.


Clinical symptoms Clostridium Difficile “C. diff”:


  • Watery diarrhea
  • Fever
  • Loss of appetite
  • Nausea
  • Abdominal pain/tenderness


Prevention of Spreading of Clostridium Difficile: “C. diff”:


If a patient experiences ≥ 3 stools in 24 hours:


  • Order a C. diff test if other etiologies of diarrhea (e.g., stool softener or laxative use) are considered unlikely.
  • Isolate patients with possible C. diff immediately, even if you only suspect CDI.
  • Wear gloves and a gown when treating patients with C. diff, even during short visits.
    • Gloves are important because hand sanitizer does not kill C. diff and
    • handwashing might not be sufficient alone to eliminate all C. diff spores.
  • In patient being evaluated for C. diff, reassess appropriateness of antibiotics.




If the patient is positive for CDI:


  • Continue isolation and contact precautions.
  • Use antibiotics appropriately.
  • Clean room surfaces thoroughly daily while treating a patient with C. diff and upon patient discharge or transfer using an EPA-approved spore-killing disinfectant.
  • When a patient transfers, notify the new facility if the patient has or had a C. diff infection.
  • CDI can be prevented by using antibiotics appropriately and implementing infection control recommendations to prevent transmission.


As discussed in last week’s blog and summary sheet, Isolation in general terms and Isolation related to coding on the MDS, must meet five requirements:


  • Diagnosis
  • Physician Order
  • Bed Placement
  • Plan of Care
  • Documentation


To see the differences, download the HHI Isolation Documentation and MDS Coding Summary Sheet.

Download the Isolation Documentation and MDS Coding Summary Sheet.


In addition, as a reminder:


According to the CDC, isolation is for people who are ill, while quarantine applies to people who have been in the presence of a disease but have not necessarily become sick themselves.


“Isolation separates sick people with a contagious disease from people who are not sick.”



“Isolation is for patients with symptoms and or positive tests.”



“Quarantine is for patients exposed but exhibits no symptoms.”


Contact Kris

Kris Mastrangelo OTR/L, MBA, LNHA, President and CEO

Harmony Healthcare International, Inc. (HHI)

Cell: 617.595.6032

Office: 1.800.530.4413




About the Authorkris-1

Kris Mastrangelo, OTRL/L, LNHA, MBA

President and CEO


Kris is a nationally recognized keynote speaker with more than 32 years of experience in the Health Care industry with a specialty in the Long Term Post-Acute Care Setting. An Occupational Therapist degree from Tufts University followed by a Master's in Business Administration from Salem State University coupled with a Nursing Home Administrator's License, affords Kris an in-depth perspective into the clinical, financial, and operational components critical for business success. Initially providing direct care as an Occupational Therapist, Kris became familiar with the Medicare, Medicaid, and multiple other reimbursement systems.


Kris is the founder, owner, President and CEO of Harmony Healthcare International, Inc (HHI) an internationally recognized, premier Healthcare Consulting firm. Kris started the company in 2001. Harmony Healthcare International, Inc. (HHI) is a recognized consulting firm that uses a systematic approach in addressing the C.A.R.E.S. platform which is trademarked and created by HHI and stands for Compliance, Analysis, Audit, Regulatory, Rehabilitation, Reimbursement, Education, Efficiency and Survey.


Kris speaks on an array of subject matters including Leadership, Compliance, Auditing and Monitoring, QAPI, Analysis, Reimbursement (PDPM, Case Mix, Medicare, Medicaid, HMOs) Regulatory, Survey (Process, IIDR, IIDR, Appeals), Five-Star Quality Rating, Rehabilitation, Program Development, MDS, Facility Assessment, Quality Measures, Value-Based Purchasing, Infection Control, COVID-19, Team Building, Staff Retention, Staff Recruitment and Revenue Cycle Management to name a few. Kris proclaims that:


"HHI’s on-site and off-site medical record review process is the nucleus for C.A.R.E.S.

optimization and ongoing systems improvement."


I. Service and Performance Requirements

II. History of Harmony Healthcare International, Inc. (HHI) and Services


Harmony Healthcare International, Inc. (HHI) founded in 2001, is a Woman Owned Small Business (WOSB) certified by the National Women Business Owners Corporation (NWBOC). With headquarters in Topsfield, MA, Harmony Healthcare International, Inc. (HHI) services clients in the following continuums:


  • Skilled Nursing Facilities (SNF)
  • Inpatient Rehabilitation Facilities (IRF)
  • Long-Term Care Acute Hospitals (LTACH)
  • Assisted Living Facilities (ALF)
  • Home Health Agencies (HHA)
  • Inpatient Hospitals
  • Inpatient Psychiatric Facilities (IPF)
  • Outpatient Therapy
  • Critical Access Hospitals (CAHs)


with Compliance, Analysis, Audits, Regulatory, Rehabilitation, Reimbursement, Education, Efficiency and Survey services. The HHI staff is comprised of accomplished HHI Consultants with expertise in the above care continuums and CARES spectrum. HHI serves the For-Profit, Not-For-Profit, stand alone and multi-facility chains across the country. ‘


Harmony Healthcare International, Inc. (HHI) has been ranked among the top 5,000 fastest growing private companies in the U.S. for three consecutive years by Inc. Magazine.



To learn more about Harmony Healthcare International, Inc. (HHI)

visit us at: www.harmony–healthcare.com




SIN Title



Management and Financial Consulting, Acquisition and Grants Management Support, and Business Program, and Project Management Services



Professional and Management Development Training


Order Level Materials


Topics: MDS, Compliance, Isolation

Kris Mastrangelo, OTR/L, LNHA, MBA


Kris Mastrangelo, OTR/L, LNHA, MBA

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