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

About noroviruses:

A breakthrough announced this week by scientists at the University of Southampton’s School of Medicine will lead to greater understanding of noroviruses, the most common cause of non-bacterial gastroenteritis around the world.

Traditionally very little has been known about the biology of noroviruses because of the difficulty in culturing and manipulating these pathogens in the laboratory. Now the Southampton team, assisted by colleagues at the University of Otago and Washington University Medical School, has devised a system for manipulating the genome of the murine norovirus (MNV) which affects rodents. This breakthrough will lead to a greater understanding of how these pathogens work and, it is hoped, lead to ways of controlling them.

Human noroviruses, which are closely related to the murine norovirus, are responsible for extensive outbreaks of diarrhoea and vomiting in cruise ships, hotels, schools and hospitals. Up to a million cases of norovirus infection are estimated to occur annually in the UK.

‘The human noroviruses have been exceedingly difficult to work with as there is no cell culture system to propagate these viruses, and as a result very little is known about their biology,’ comments Professor Ian Clarke, who heads the Virus Group at Southampton.

‘In the absence of a cell culture system, MNV is a surrogate for study of the human noroviruses. This study represents the culmination of a ten-year research quest in Southampton to obtain recovery of a live norovirus from its nucleic acid.’

The team in Southampton included Drs Vernon Ward, Christopher McCormick, Omar Salim and Paul Lambden and Professor Clarke. Together with Drs Larissa Thackray, Christiane Wobus and Skip Virgin at Washington University School of Medicine they devised a novel way of introducing a complete DNA copy of the MNV RNA genome into human cells grown in the laboratory. This allowed recovery for the first time of intact, functional viral particles from human tissue culture. They also used their system to mutate the virus so that they could identify a sequence that is essential for viral replication.

Their reverse infectious genetics system will be an essential tool for understanding the replication and molecular biology of this and human noroviruses and will help in the development of antivirals aimed at controlling infections.

The work, which was funded through a Wellcome Trust project grant, is published in the Proceedings of the National Academy of Sciences (USA) this week.

Good work. Now if we get these antivirals to work…

FYI:

People are catching MRSA more and more often now- out in their communities as well as via a hospitalization. Scientists are working on vaccines to create immunity to this menace.

MRSA, a type of staph infection resistant to most antibiotics, is affecting more and more healthy people as a new strain emerges in the general community. The infections are becoming increasingly resistant to antibiotics as a new, more potent strain emerges outside the hospital — especially among athletes who come in close contact. Typically, MRSA doesn’t get worse than a skin boil, but it can lead to severe problems and sometimes death.

“It hits healthy people. It actually seems to be much more virulent, and it can produce toxins and actually make people very sick, very quickly,” Tom Talbot, M.D., an infectious disease epidemiologist at Vanderbilt University in Nashville, explained.

That’s why scientists are developing a vaccine to stop MRSA in its tracks.

In one study, the Staphylococcus aureus Polysaccharide Conjugate Vaccine, or StaphVAX, appeared to protect 94 percent of people.

This sounds promising.

This is a little old- from the beginning of March. It seems MRSA and copper do not go together. Interesting.

Stainless steel door handles and taps at a hospital are being replaced with copper ones in an effort to reduce the presence of the superbug MRSA.

Scientists think properties found in copper can reduce its presence, as opposed to stainless steel, a commonly used metal in health centres.

Birmingham’s Selly Oak Hospital is swapping steel for copper in an 18-month trial to test the findings.

At least 5,000 people are likely to die every year from the MRSA infection.

Exposures to blood and other body fluids occur across a wide variety of occupations. Health care workers, emergency response and public safety personnel, and other workers can be exposed to blood through needlestick and other sharps injuries, mucous membrane, and skin exposures. The pathogens of primary concern are the human immunodeficiency virus (HIV), hepatitis B virus (HBV), and hepatitis C virus (HCV). Workers and employers are urged to take advantage of available engineering controls and work practices to prevent exposure to blood and other body fluids.

CDC/Bloodborne Pathogens

I’m surprised to see this is happening without civil rights advocacy groups questioning the privacy of patients.

“It’s everywhere,” explained Dr. Rick Hartman, the medical center’s physician champion for the MRSA-prevention initiative. “It lives on your skin, in your mouth, in your nose. It even lives on tabletops.”

Hartman said that about 10 percent of the patients who visit the medical center have MRSA colonies in their bodies, usually inside their noses. But, in most cases, there are no symptoms.

“People have it, and don’t even appear to be sick,” he said. “Most people’s body can keep it in check. When it becomes a problem is with at-risk patients — elderly patients, infants or people who are already sick and weak.”

Depending on where the bacteria decides to settle, MRSA can cause a variety of infections, some more serious than others. That’s why the national VA hospital system has made it a goal to completely eradicate the spread of the bacteria in its hospitals.

To stop the spread of MRSA and the infections it causes, Hartman said, the medical center is taking a number of steps. First, the staff has begun testing anyone who is admitted to the hospital. If someone tests positive for MRSA, they are placed in a hospital room by themselves, and doctors and staff members treating them are required to wear gloves and masks and wash their hands after coming into contact with the patient.

This is a good initiative. Let’s hope it stands up to those who might see this as a violation of privacy rights.

Across the pond they have identified a new strain of MRSA. It’s only a matter of time when we will see this in the US.

A healthy hospital worker died after contracting a deadly new strain of MRSA that had never before been reported as a cause of death in hospitals.

Four other workers at the same hospital also contracted Panton-Valentine Leukocidin-positive (PVL) MRSA, with two of their friends, said the Health Protection Agency. An investigation subsequently found that the strain had killed a patient at the hospital earlier this year.

The strain, which is particularly virulent, attacks healthy young people and can cause symptoms ranging from minor infections in the skin and soft tissue to a form of pneumonia that can kill in 24 hours.

The outbreak, which has only just been reported, was identified when a previously healthy female healthcare worker, named only as “Case One”, developed a severe MRSA infection and pneumonia and died after emergency surgery in September, the agency said.

The bacterium that she had contracted, PVL-positive MRSA, had never been found to cause a death inside a hospital. It was contracted by at least three other workers in two wards in a West Midlands hospital, and two of their friends.

It was also found to have caused the death of a patient at the hospital in March.

A statement from the agency said: “Eight cases of PVL- positive community-associated MRSA have been identified among individuals in a hospital and their close household contacts in the West Midlands. Four of these individuals developed an infection, two of whom subsequently died.”

Doesn’t sound good- these new germs keep mutating and turning into things we cannot treat.