Nursing Assistant Resources On The Web

C Diff. The infection that can run rampart in nursing homes and hospitals. Nursing Homes Magazine has an article about this nasty illness we deal with, often:

Clostridium difficile—also known as C. diff—is a bacterium commonly found in hospitals and long-term care (LTC) settings. Infection can lead to diarrhea, colitis, and other symptoms that can be debilitating and even deadly, particularly in the elderly. In recent years, there have been several reports of infection affecting both individuals and whole groups of patients treated in hospitals and healthcare facilities around the world. Based on available reports, hundreds of thousands of people experience symptoms related to C. diff infection each year, and that number is growing as more virulent and resistant strains emerge.

Some interesting facts:

Although clinicians report that C. diff spores are present in most hospital and LTC settings, many questions remain as to why some infected patients go on to develop symptoms while others do not. In fact, most of those infected—70–90%—experience no symptoms at all. Others go on to develop symptomatic disease and potentially recurrent life-threatening symptoms.

I always assumed those who tested positive for C Diff had the symptoms as well.

While discontinuation of antibiotic therapy is generally the first-stage treatment, it can also introduce serious risks for some patients. A sudden cessation of treatment might reexpose patients to the infection that therapy was originally intended to treat or prevent. Also, after cessation of antibiotic therapy, treatment typically—and paradoxically—involves the use of antibiotic therapy. This makes C. diff infection one of the few health problems that is both caused by and treated with antibiotics.

This makes sense of course.

There have also been some difficulties recorded with the use of antibiotic therapy to treat this infection. Patients treated with metronidazole, an antibiotic commonly used to treat moderate infection, show a failure rate of at least 10% and a recurrence rate reaching 30% or more. Many experts also express concern that treatment with vancomycin, prescribed for more severe cases of infection, could be contributing to greater drug resistance among other infection-causing organisms. In recent years, there have been many reported cases of selection of vancomycin-resistant Enterococcus species following treatment with the antibiotic.

NOT what we need: C Diff to become a superbug.

Many infectious disease specialists believe that new and more virulent strains of C. diff could someday represent a potentially serious threat to public health. As researchers explore possible correlations between strain virulence and higher incidences of community-acquired CDAD, clinicians have become particularly concerned about strains of community-acquired CDAD occurring in people who have not previously been treated with antibiotics. A recently discovered epidemic C. diff bacterium produces up to 20 times more toxin than other strains and, even more ominously, appears to be resistant to fluoroquinolone antibiotics such as ciprofloxacin and levofloxacin. This strain has thus far been found only in hospitalized patients and some LTC facilities and not in the community.

And this news doesn’t surprise me at all: Community acquired C Diff. The challenges this will present will be very difficult to deal with.

Heightened awareness of C. diff could help facilities develop more effective preventive strategies to reduce incidences of infection. Most basic strategies call for increased attention to personal hygiene. Because the primary means of transmission seems to be via the hands of healthcare workers and other patients and residents, proper sanitation (handwashing) and barriers (gloves, gowns) are considered by infectious disease experts to be the most effective measures of disease control in healthcare settings. Regular and thorough cleaning of patient rooms with antibacterial cleaning agents—including bleach at a 1:10 dilution in water—can be effective in reducing the presence of C. diff spores in the environment.

We can’t say it LOUD enough: WASH YOUR HANDS. WITH SOAP AND WATER. DO not use gel sanitizers- they don’t kill all the spores. I know of a few nursing homes in my area that insist the staff DO USE the gels, and also, use the gels to wipe down surfaces and door knobs! These places have entire units of residents infected and re-infected with C Diff…it’s because they’re not following the proper hand cleaning procedures.

CDC Web Site on C Diff