ahh

[thisnurse]

the smell of c-diff in the morning

[thisnurse]

thing about c-diff is that you know it when you smell it. patients with cdiff have stools that all smell the same. it is one horrible smell.

and it stays in your nostrils for hours. sometimes id like to run water up my nose just to flush it out....lol

the WORST smell is gangerene. had a paraplegic patient with bilateral lower extremity gangerene. his right leg was so rotted i was afraid to lift it because i thought it would fall off in my hands.

upon arrival to er, they had to remove maggots from it.

this guy decided he was going to kill himself with gangerene.

he changed his mind when the neighbors in his apartment complex complained about the smell.

a mask in his room was a necessity. even still the stench was gagging. one of the assistants threw up.

the entire floor had to be sprayed for smell.

smells are one of the percs of the job...lol

[biscuit_007]

well, for all you peds nurses out there; how about rota virus stool

[wrightgd]

Thanks to all who have posted here... I was cruising the BB while finishing my lunch at work... Like a true nurse, I finished the entire meal without hesitation...

It's been a while since I had a pt with c-diff, so thanks for the reminder of why I'm behind a desk now... And major kudos and thanks to those floor nurses who wade through blood and guts (and c-diff) every day...

Now if you will excuse me, I have to go shower to rid myself of this wonderful aroma...

George

[NurseDennie, BSN, RN]

This is a great thread! I'm eating lunch right now - I tried the new Mandarin Orange salad from Wendy's. Pretty darn good, but the salad dressing is too sweet and not enough sesame.

I agree with all of you guy's favorites. The C-diff reminds me of one of my favorite patients. C-diff neuro patient, paralyzed but pretty much with it. I went in there to give her meds, and sure enough, she had stooled (C-diff stools not only all smell alike, but they look alike, too) so I cleaned her up, changed the bedding, she stooled again, I cleaned her up, was putting a salve made out of maalox and babypowder on her, she stooled again.... I was literally in there for an HOUR. I finished cleaning her up for about the seventh time, and she stooled again. She sighed, and said "I'll ignore it if you will."

I told her I loved her but I couldn't ignore it, but I did have to leave. I went and called a tech to clean her up a few more times. (G)

Love

Dennie

[joyrochelle]

Clostridium difficile is a gram-positive, sporulating anaerobic bacillus that typically does not colonize in the gut , Metronidazole and vancomycin are the most common medications used in the United States because they inhibit the growth and toxin production of Clostridium difficile.

wow....perhaps i need to go back to micro, but they use an antifungal for a gram neg. bacillus??

this c. difficile sounds absolutely terrible/awful/no-good/very-bad ....NASTy.

-----L&D bound with good reason.

[P_RN, ADN, RN]

Well let's add some necrotizing fasciitis in a 5oo# man with diabetes.

Now let's picture Me "P" coming out of the room and wondering what all the hoopla was.......(discovering that she no longer had a sense of smell due to unknown reasons at the time).

Anyway I was the chosen one to care for this lovely man. He died soon thereafter. I never did tell him I can't smell. :)

[SICU Queen]

L&D bound with good reason.

:chuckle Yeah, until you get an order that reads "Kwell bath all over body stat."

[mario_ragucci]

Squirrel - you've done it again !!!! You always plant seeds and reap thoughts from me. I wish I could listen to you talk all the time. I just recently completed microbiology, but we didn't cover probiotics, which you introduce, and I find to be drugs which enhance the growth of bacteria. What is a prebiotic? That one I couldn't find yet.

Also, this post solidifies my assumptions about human olfactory perception and bacteria end products. Different types of bacteria have different end products, and humans can detect various end products. I learned that with various petri dishes in microbiology, but for me, it solidifies once I hear people actually talking about it. It takes I different meaning, and becomes larger.

Gases produced by bacteria living in our guts can be described by people as "sweet" or "silent but deadly." As you so wonderfully explain, clostridium difficile is the result of a specific enteric environment. And I am assuming, clostridium difficile produces specific end products, compared to e coli, for example, or other flora. We note here, people can surely detect the difference in smell. And I feel our olfactory sence can identify C-diff, if we allow it, because our olfactory bulbs have receptors for it.

Put more realistically, it opens my eyes (not nose) to what a stool specimen is looking for...end products....what kinds of infections might be present within an ill person, specifically, and what drugs would best treat them.

Thank you Squirrel :-)

[Squirrel]

(Clostridium difficile is a gram-positive, sporulating anaerobic bacillus that typically does not colonize in the gut , Metronidazole and vancomycin are the most common medications used in the United States because they inhibit the growth and toxin production of Clostridium difficile.

wow....perhaps i need to go back to micro, but they use an antifungal for a gram neg. bacillus??)

Joyrochelle: Metronidazole is another name for flagyl, which is effective against anaerobic bacteria and protozoa. Perhaps you were thinking about Miconazole which is another name for monistat? You are right, you would not use an antifungal agent to treat a gram negative bacillus.

Mario:

Glad the information helped. I am pasting the introduction to the paper which gives some information about probiotics and prebiotics:

In 1908 Elie Metchnikoff associated the longevity of Caucasian people to their intake of fermented milk products containing lactic acid bacteria, and he proposed that there was a beneficial effect from the bacteria contained in yogurt which he postulated replaced the normal gut flora (1). Metchnikoff isolated the culture la Lactobacilline which was used to produce a yogurt that was successfully introduced at the beginning of the 20th century in Paris, and since then, live bacteria have been used in milk based products (2). Lactic acid bacteria are gram-positive, nonsporulating organisms that are anaerobic but aerotolerant, and they are acid tolerant with lactic acid being their product of fermentation (1).

The term probiotic was first used in 1965 to describe products secreted by a microorganism that stimulated the growth of another microorganism, and it was contrasted with the term antibiotic (3). In 1992 Havenaar et al defined a probiotic as: "A viable mono or mixed culture of microorganisms which applied to animal or man, beneficially affects the host by improving the properties of indigenous microflora" (3). Gibson and Roberfroid defined the term prebiotic as: "A non-digestible food ingredient that beneficially affects the host by selectively stimulating the growth and/or activity of one or a limited number of bacteria in the colon." This definition differs from the definition of fiber in that prebiotics are selective for certain bacterial species while dietary fiber is not (3).

Probiotics are nonpathogenic yeasts or bacteria, in particular the lactic acid bacteria, that have a positive influence on the health of the host, and their effects are either direct or indirect via modulation of the endogenous microbial flora or by affecting the immune system (4). The adult microflora of the intestine contains approximately 500 different bacterial species, some of which are potentially harmful due to their ability to produce toxins, act as carcinogens, stimulate inflammation, and invade the gut mucosa (5). The beneficial strains are of the genera Bifidobacterium, Eubacterium, and Lactobacillus while the potentially harmful ones are of the genera Clostridium, Shigella, and Veillonella (6). There is an alteration in the gut microecology during inflammatory and infectious conditions that promote the growth of potentially pathogenic organisms, and the host and microbe interaction is disrupted such that an immune response may be evoked by the normal bacterial flora (5). Studies have shown that the use of probiotics can improve human gastrointestinal function and decrease the risk of illness. To be considered a probiotic, the organism must have its physiological benefits scientifically proven, be of human origin, be safe for human consumption, be stable in gastric acid and bile, and it must adhere to the intestinal mucosa (5).

The goal of a prebiotic is to stimulate the growth of the beneficial strains of the indigenous microorganisms, and by doing so, modify the gut microecology (6). The inulin-type fructans seem to have the best prebiotic effects, and the bifidobacteria species are well adapted to utilize these non-digestible oligosaccharides (6). For a food component to be considered a prebiotic it must resist digestion, be fermentable by colonic microflora, and selectively stimulate the growth of a limited number of bacteria in the feces in vivo (6). The prebiotics inulin and oligofructose are found naturally in varying quantities in foods, and are present in over 36,000 different plants including onions, bananas, wheat, chicory, and garlic (7).

Clostridium difficile pseudomembranous colitis and ulcerative colitis are two disease processes where there is an alteration in gastrointestinal physiology and function, as well as a disruption in the gut microecology. This paper will explore the use of probiotics and prebiotics in the treatment of these two conditions, and issues relating to the viability of various probiotic products will be discussed.

By the way, I cannot figure out how to quote someone else like others do. Can you tell me how you do that? Thank you very much!

[mario_ragucci]

Originally posted by Squirrel

(By the way, I cannot figure out how to quote someone else like others do. Can you tell me how you do that? Thank you very much!

It's easy squirrel - just 1. goto the message you want to quote from 2. click on "quote" at the botom of the message you want to quote from 3. when you do, a response window opens up, with special text characters on both ends of the entire body of the message you selected quote at 4. you should edit (delete) the text you do not want to quote, and only leave the text you want to quote, unlike some folks who spew quoted text around and it cluters a message, making it unworthy of consideration. You can also type in your own message along with the quoted text at the top, like I am doing here.

Sincerely,

Mario (the bacillus end-product) Ragucci

[thisnurse]

squirrel...are you saying that antibiotics might be a second defense to cdiff?

if im following you right, you are saying that this infection can be controlled by simply changing the bacterial ecology of the intestine?

the drugs we use to treat cdiff are unasyn and flagyl...would be great if we didnt have to administer the antibiotics.

is cdiff something that is exclusive to the ill?

i realize its a nosocomial infection with contact precautions, but how common is this in the normal healthy health care worker?

i guess what im asking is if say i didnt practice precautions...what would the chances of my actually coming down with this?

i cant recall ever seeing it in a "healthy" person. the patients we get that are positive are pretty debilitated.

thanks for the info

[judy ann]

This entire thread confirms what my dad always said about nurses. "They have a wierd sense of humor and a wierder sense of smell." However, C-Diff is the only smell indiginous to medical facilities that can be diagnosed by simply driving by.