RN with relapsing cdiff

  1. Despite my best handwashing efforts, gowning and gloving, I got cdiff. Three months ago. I just relapsed.

    It has been a complete nightmare. I can't return to work. I can't eat. I'm in pain, I have fatigue, etc.

    Now I have three more months to completely get better or I will be terminated. The hospital says that I can't prove that I contracted the c.diff there....and I'm harassed by HR to 'prove' that I'm still sick. Do they HONESTLY want me to PROVE that I have c.diff? Don't they think that I could find other things to fake other than this horrible disgusting illness?

    My question is, have any ID nurses noticed an increase in your workers contracting c.diff, or a general increase in c.diff in your patients. About the time I got sick, I was on antibiotics, a very bad one in terms of c.diff. But others in my hospital have contracted it (RNs, CNAs and the like), and its seems that half of our ICU unit has it at sometime or another. Any advice would be helpful. Also, I wasn't even offered workman's comp, and I'm financially drowning....

    Thank you

    ~Amanda
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  2. 30 Comments

  3. by   prmenrs
    Your MD (or PCP) should be able to document that you have this disease. Also, request an ID consult (I'm assuming you still have insurance--oh, please!!) so you can speak to a specialist. It would be good if that consulting doc is affiliated w/your institution, s/he might be able to help.

    Contact the Infection Control Practitioner, also the Public Health dep't may be able to help re: any outbreaks in the community. Try to remember any restaurants you went to before you became ill.

    You may need the help of an attorney re: the employment/workman's comp/HR issues. Do you remember any of the pts you took care of that might have had this?

    You might have to also apply for disability.

    I feel terrible for you--I can just imaging dealing w/all this while your GI tract is--well, never mind. Best of luck!!!
  4. by   rjflyn
    Number one rule- if you become ill or hurt at work don't go it alone, contact a workers compensation lawyer. But I can;t afford a lawyer, can you not afford one, most work on a contingency ie 30% of nothing is nothing so whats one have to lose. The rules and regs are too complex to figure out by oneself. Do you think for one minute the hospital doesn't have an attorney working for them on these issues.

    RJ
    Last edit by rjflyn on Oct 20, '05
  5. by   RM23
    As a note re the post of worker's compensation attorneys. If the attorney does w/c then they are paid directly by the state, usually. It is a set fee of either 12 or 15 %, not sure. Worker's compensation attorneys can not ask for money from you as it regulated by either federal or state laws. Contact a w/c attorney, dont let the hospital ignore the problem. Hospitals do not want to take responsibility and admit there was a mistake, etc. and they certainly do not want w/c cases as their insurance rates go up. Having been in many a meeting with risk managment, insurance ppl and hospital management, I know they will not accept responsiblity. BUT, yhou can file a w/c claim,, GO FOR IT and take care of yourself.. don't listen to them.. they are not out for your best interest, unfortunately that is the name of the game.. good luck, sorry you are having such a hard time.
  6. by   ladyofexcellance
    Is there a cure for c-diff

    How long were you ill with the disease. What medications were you on.I am at a complete loss for my friend. How can I help? Is this usuall a long drawn out rehibiliation.

    Quote from ladyofexcellance
    Is there a cure for c-diff

    How long were you ill with the disease. What medications were you on.I am at a complete loss for my friend. How can I help? Is this usuall a long drawn out rehibiliation.
    I see one person wrote that weveral persons in her facility had c-diff at one time or another. Is there a cure? If the disease is so contagious and no medication is capable of toppint it, why isn't it treated like TB or Cancer.
    Last edit by ladyofexcellance on Oct 24, '05 : Reason: Automerged Doublepost
  7. by   RNinPGH
    Supposedly one round of flagyl was supposed to cure me...but 5 days into the flagyl treatment, I became violently ill and required hospitalization.

    I went on vancomycin for a month, 250mg QID, test negative for cdiff x 3 stools but still had symptoms.

    I was scoped to see if something else was causing symptoms, and I was found to be cdiff positive again.

    So now I'm on a second round of vanco, this time at 125 mg QID, I'll be done with my second week on Friday, but I still am VERY symptomatic, can't eat, extremely fatigued, have muscle pain, etc.

    Its been THREE months since I initially became ill. I can't work due to my 'cdiff positive' scourge.

    According to my research (which is scant, no one wants to make new drugs or research this bacteria), 80% of those who get it do fine with one run of flagyl or vanc. Apparently they both have the same effectiveness, but vance is SOOOO expensive ($1000+ cash price for a two week course). I'm one of the 20% that looks to have 'relapsing' cdiff that can turn into a chronic condition. I can look forward to having relapsing events until I die. I will forever have to be wary of any kind of infection I get, and need to seriously talk over any kind of antibiotic treatment with my doc.

    With work, I do plan on returning to my job, if I ever get rid of this bacteria, and if my job is still there when that happens. But I'm not allowed to take care of c.diff patients. So there goes half my ward.

    I don't know why cdiff isn't treated more carefully as it should be. It is transmitted through the fecal oral route, which should make it hard to contract, but it is transmitted through spores which can survive in the environment for up to 40 days outside the human body. Only bleach can kill it.

    Most nurses I know don't know that. And most nurses I know (including myself) didn't know about the extreme pain and muscle fatigue and anorexia associated with it. They think its just bad diarrhea. Most of our patients with it were on the stairway to heaven to begin with...so no one paid attention. Most nurses figure that they are colonized for everything anyway.

    Also to note: I was on heavy antibiotics when I became ill, most nurses don't know that they are VERY suseptible to their patients illnesses when they go to work sick. I found out the VERY hard way.
    Last edit by RNinPGH on Oct 24, '05
  8. by   CoffeeRTC
    I've just read an article in either the Post Gazette or the Trib about the spread of Cdiff in the local hospitals. I think it was last week?

    I've done a little research on Cdif for a resident that was plagued with it. There are some online and I think in person support groups. You are not alone. I work in LTC, so I've seen my share. It is a debilitating illness, esp when you are elderly, too. We have pts on Flagyl for at least 21 days, some longer. Vanco too. Also we are using Lactinex, yogart and Florastor. I've heard that macaroons (cookies) help ease the diarrhea? Do a search on this site.....I think we had info on this. Have you heard of a stool transplant?

    We were just talking about this at work....Should this be a workers comp issue? Heck you got it at work.

    Sorry to have to run in to a fellow Burg nurse this way.
  9. by   tevans95b
    Sorry to hear about your difficulties with C. Diff. I'm sure it's more miserable than it sounds. We have a doctor that has decided that after seven days of Flagyl PO the patients are cured and don't need to be isolated. Our ICP had always said six months contact isolation. Yes, we've seen an upswing of C. Dif cases. There's a study being done that hypothesizes certain antibiotics used today make a patient more prone to C. Dif. What were you on? The Vanc you were on, you took it PO? We usually treat w/PO flagyl and IV vanc, as long as it crosses the gut. Good luck!
  10. by   RNinPGH
    I thought it was known that IV vanc doesn't cross into the gut, thats why its primarily INEFFECTIVE against cdiff? That is what ALL the literature I have read to date has stated. The PO vanc (which I have been on intermittently since July) doesn't cross INTO the bloodstream, essentially sparing my kidneys. My first round of PO flagyl became ineffective after 5 days of treatment, I horribly relapsed and ended up as an inpatient for a couple of days. My current dose of vanc, which is now doing NOTHING for me, which is making me question a possible VRE experience, is 250mg QID PO.

    I was an inpatient last week, and despite two stools coming back negative, I was still in isolation, the ID docs explaining that since I was on vanc, my tests would logically come back negative, the vanc suppressing the toxins. The same reason why you get a blood culture BEFORE you start IV antibiotics. The proper way to test, is to be off vanc (or flagyl) for two weeks. If I were any nurse on any unit anywhere and had a pt with a HISTORY of cdiff, I would gown and glove and take every precaution for my own protection. YOU DO NOT WANT THIS RUINING YOUR LIFE!!!!!

    As a result of the cdiff, I have now developed fibromyalgia, which my docs say is a direct result of battling this bacteria for so long. I have lost nearly 30 pounds to date, been off work at 60% of my salary (which is a BIG loss if you add it up), and have been paying out the butt (ha ha) for meds/copays/tests/hospitalizations and the like.

    BTW, I was first on Augmentin 875mg BID for 5 days, which did not touch the symptoms of severe otitis media, then Avelox 400 mg QD for 10 days before I had the first symptoms of cdiff. I really don't want to know what was growing in my ear that didn't respond to the Augmentin at that dosage.

    I'm happy I don't have your doc treating me

    If you want more info about what your docs SHOULD be doing, please see the cdiff support site's FAQ section: www.cdiffsupport.com
  11. by   jmgrn65
    our facility says that once positive the patient will remain positive for a long time, we take them out of isolation when thier stools return to normal usually two formed stools and no diarrhea for 2 days. Hope you get better soon.
  12. by   jewelcutt
    I have a lot of experience with this. I'm a nurse who worked in the ICU. Cdiff spores are all over the place, everyone working in the hospital probably has them. When you take a lot of ABX, escpecially certain ones, the spores germinate and cdiff toxin attacks your colon and you get sick. The spores live for two years in your colon, and usually a year on inorganic surfaces (curtains, tabletops), and are very hard to disinfect. I initially got ill from taking clindamycin (known to cause cdiff), and unfortunately didn't know it was cdiff. I was put on other abx, they were thinking I contracted some bacteria from mexico. This only made the cdiff worse, gave me an allergic reaction to the toxins and everything. So I was sick for about a month with diarrhea. I was told to try different things, like immodium (antidiarrheals make it worse and multiply faster), lactobacillus because they thought I had just wiped out my normal flora. Well, I finally became dehydrated and in pain enough that I passed out transporting a patient at work one day. I was up to like 14 stools of water a day, and ended up being rehydrated in the ER with 5 liters before my mucosa started to look more hydrated. Why didn't I realize this, why didn't my family doctor? I had good days and bad days and was so busy that it didn't occur to me. I ended up getting a scope.

    So, there is a very bad strain of cdiff going around. Yes, it is extremely important to was hands and use contact precautions so you don't spread it to other patients. But the truth is, all of us healthcare workers have the spores if we work around cdiff patients. I spoke with the ID doctor at our hospital trying to figure out how I got it. He said he wasn't surprised at all, and if you cultured the unit phones they would be crawling with cdiff.

    When you let cdiff get bad, like I did, it takes a while to get rid of it. Flagyl never worked for me, besides the fact it made me really nauseated. Vanco works great, but you will need more than a two week treatment to get rid of it. It has to be PO vanco, and this doesn't get absorbed systemically.

    #1- don't take pepto bismol, immodium, or other antidiarrheals, it will make the cdiff worse.

    #2- you need to take a form of lactobacillus to keep the good flora in your intestines at normal levels to combat the cdiff and make you less susceptible in the future from getting it. In the future, if you feel your immune system low, it may be a good idea to take a month's worth of it to keep you safe. There is a great brand that doesn't need to be refridgerated. It's called culturelle. You can get it at a walgreens, usually in the herbal section.

    #3- The symptoms will last for a while, even though you may be free of it. This happened to me.

    #4- You are probably experiencing problems and symptoms now because you either got a really bad case of it, let it go on too long without treatment, or are dehydrated. You need to keep hydrated with this. I lost 15 pounds in a month even with trying to keep myself hydrated.

    #5- I hate to say it, but a bland diet is what you need for a while. Yogurt is great because of the cultures in it.

    #6- Make sure you have a good GI doc. Don't rely on a family doc to treat this.

    #7- You shouldn't take any antibiotics for at least two years, until the spores are out of your system. So, take MVI's, especially if you feel yourself getting sick. I take vit c and zinc when I feel myself coming down with something. If you need to take abx, you should also take flagyl and lactobacillus with it to prevent a cdiff outbreak.

    #8- If your stomach feels very active, lots of butterflies, excessive bloating and gas, it's a good idea to call your GI doc and send a stool sample in.

    #9- If you know it has come back, don't delay. My doc gave me an extra prescription of vanco to keep on hand in case it came back. Early treatment is the key to nipping it in the bud. And those of us who have had it know exactly what it is when it comes back.

    Mine came back after a year, I hadn't been taking any antibiotics, I think my immune system was just low, so I immediately started abx and sent in a sample and started feeling better the next day. It'll take a little while to totally get rid of it. Keep your head up, you will get rid of it, you just need to catch it earlier. Don't wait for a week to hear back from stool results, start vanco right away. I never knew how painful cdiff was for my patients until I got it. I actually had gastritis and pseudomembranous colitis because of it. People have been known to get colectomies because of cdiff. It's just not watery diarrhea. People need to treat it more seriously.
  13. by   RNinPGH
    Thanks for the tips. More nurses need to be aware that its not just 'watery diarrhea', this is so painful, and it stays with you for a LONG LONG time.


    I had a horrible bout of otitis media and was on two heavy antibiotics within two weeks, that is what triggered the cdiff in me. I knew right away what I had when Immodium didn't work for two days. My (former) PCP did not believe me, but ordered the stool test just to humor me, and it was positive.

    In this new age of 'superbugs' and antibiotic resistance, nurses have to take more precautions to protect themselves. Its just a fact.

    My dad often tells his grusome tales of critical care nursing in the earlie 80's, when they didn't use gloves or contact precautions. He tells me about being elbow deep in someone elses blood and not thinking anything of it. And then he adds "And I never caught anything". I can usually handle any gross story that is thrown at me, I've seen alot in the ICU, but those stories make me shudder. And being where I am now, well into the fourth month of battling this illness, being scoped from every direction, being on the other side of the bed, all I can say is PROTECT YOURSELVES, no one else will look out for you but you.
  14. by   shock-me-sane
    this post scares me.

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