Quote from Butternut
Are you seeing a lot of C-Diff? There has been so much lately, it seems. Not knowing a whole lot about it and researching it online, some articles say "no cure" others read antibiotics are making people more susceptable to getting it and more articles call it "recurring."
When you are caring for these patients are you gowning up or just gloving? I read in one article that the spores are still alive even in the room and on equipment, AFTER dismissal, for months, if not properly killed with bleach!
Scares me! What if one of our family members get it or what if we get it from caring for the infected patient?
Once a carrier, always a carrier or do they ever really cure someone?
The general public need to know about these super-bugs now and how they are contracted, the terrible symptoms of chronic, watery stools of C-Diff and what if anything alleviates the problem.
C. diff (Clostridium dificile) does produce spores however they should be killed by normal room termination. C. diff is a more or less normal part of the stool (although some disagree). Depending on your source 10-20% of the population is colonized. Nursing home patients have a much higher rate of colonization. Transmission by oral fecal route.
Normally C. diff exists in the colon along with the normal colonic flora. However, C. diff is resistant to most antibiotics. When a broad spectrum antibiotic is administered then the normal flora is wiped out and the C. diff moves into the space occupied by the other bacterial (the normal state is called competitive inhibition). This is mostly associated with cephlasporis and Augmentin. C. diff produces a toxin which if there is enough bacteria causes colitis (inflammation of the colon). This causes high output watery diarrhea referred to as C. dif associated diarrhea (CDAD). The other name for this is pseudomembranous colitis. This can make someone extremely ill. It also usually produces headache and nausea. This can rarely cause death, but usually in debilitated patients.
This has been around for many many years. There are two developments that make this situation worse. The first is the development of bacterial resistance. Flagyl has been the mainstream treatment for years. However in the last five years there has been increasing resistance to Flagyl. The other approved treatment is oral vanco. This is extremely expensive, but very effective. In the last three years there has been isolated but increasing reporting of Vanco resistant C. diff. There are other off label treatments but the resistance is scary.
The second development is the BI/NAP-1 strain. This is a strain that produces both the A and B toxin at 20 times the normal levels. It also is resistant to Levaquin which is a recent development in the bacteria. This strain is characterized by a high white count and rapid progressive multi-system failure which can lead to death. If the WBC is over 50 and there is kidney failure the mortality is nearly 100%.
Isolation should be gown and gloves to avoid transferring spores to other patients. As usual no nurse with an infectious patient should be taking care of an immunosupressed patient. Good handwashing is a must.
Here is a good reference from CDC:
Here is the article on BI/NAP-1:
See if your state has epidemic C.diff:
Here is another decent article:
David Carpenter, PA-C