C-Diff question

SweetOldWorld, BSN, RN · Aug 24, 2009

C-diff is thought to be a naturally resident gut flora, right. And use of certain antibiotics, plus other risk factors, put a patient at risk to get over-growth c-diff resulting in diahhrea.
Well if it's a naturally occurring bacteria, why is it conidered contagious? It's supposedly highly correlated to long hospital stays, but that is d/t long term exposure to certain abx, or is it because we are passing it from pt to pt? I just dont' get how you can spread something that's already supposedly residing there.

This is a good question, and I think the key lies in the sheer number of bacteria involved plus the underlying health of a person exposed. Hospitalized patients who are already sick or immunocompromised are more likely to become sick if they are exposed to c diff (which is shed in stool and which forms spores that are hard to kill and can last out in the open a long time). The bacteria probably take advantage and quickly multiply when they are transferred to a new person, and only someone who is basically healthy to begin with can easily fight off an overgrowth and subsequent infection with c diff.

A quick google search also tells me that only 2 - 5 % of the population are colonized with c diff, so maybe it's not really so common a gut flora after all.

Interesting question!

breaktime · Aug 24, 2009

This is from MayClinic.com

C. difficile bacteria can be found throughout the environment-in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.

C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.

People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.

Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.

An aggressive strain of C. difficile has emerged that produces far more deadly toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. This strain of C. difficile has caused several outbreaks of illness since 2000.

http://mayoclinic.com/health/c-difficile/DS00736/DSECTION=causes

The above pretty much is just a rewording and confirmation of what SweetOldWorld said, but I thought it might be helpful.

nerdtonurse?, BSN, RN · Aug 24, 2009

And don't overlook the "in the wrong place" issue. You can have e. coli that lives in your Gi tract and all's well and good. If you get it in your urethra, not so good. If you get someone else's normal GI flora/fauna into your system, you get sick as a dog -- and if you don't think that's so, go to Mexico and drink the water... *grin*

sasha2lady · Aug 24, 2009

Last year we had a swarm of c diff rehab pts come in....4 actually died. They came to us from the hospital with it. I think the contagious part comes in from the fact that the c diff spores can live on a surface for several weeks...mos even ....i read that the only thing that will kill the spores is a bleach and water cleaning agent..which we cant even use at my job anymore. the industrial cleaners dont kill it. so......its easy for us to carry it around...if someone throws dirty linen from a c diff pt on the floor as we all know this happens.....we walk all over that floor...and take it not only room to room to others ..but to our cars and homes. I had to take my 2 yr old son to the md after this happened at work b/c he started having c diff like diarhhea....he had it for 6 weeks....had him tested for parasites and rotavirus and I insisted on a c diff test which the md didnt want to do...but how did i know he didnt grab one of my shoes from work and put it in his mouth ? all was negative.....so I cut his milk out and changed it to soy for about 2 wks....cleared him up. Just goes to show that its the things we cant see that can make us and others terribly sick.

*ac* · Aug 24, 2009

Last year we had a swarm of c diff rehab pts come in....4 actually died. They came to us from the hospital with it. I think the contagious part comes in from the fact that the c diff spores can live on a surface for several weeks...mos even ....i read that the only thing that will kill the spores is a bleach and water cleaning agent..which we cant even use at my job anymore. the industrial cleaners dont kill it. so......its easy for us to carry it around...if someone throws dirty linen from a c diff pt on the floor as we all know this happens.....we walk all over that floor...and take it not only room to room to others ..but to our cars and homes. I had to take my 2 yr old son to the md after this happened at work b/c he started having c diff like diarhhea....he had it for 6 weeks....had him tested for parasites and rotavirus and I insisted on a c diff test which the md didnt want to do...but how did i know he didnt grab one of my shoes from work and put it in his mouth ? all was negative.....so I cut his milk out and changed it to soy for about 2 wks....cleared him up. Just goes to show that its the things we cant see that can make us and others terribly sick.

I'm guessing that the fact that most of us (health care workers) and our families don't get it, is that we have healthy immune systems and aren't taking the big-gun abx that kill off the good flora. So we can be exposed to it and not get sick. However, I'm thinking that we can easily carry it (on shoes, etc), or by being harmlessy colonized (like MRSA) to pt's who can't fight it off d/t their long-term use of abx or other type of immunosuppression.

The whole infectious disease, isolation procedures, colonization vs infection, etc is very confusing and interesting to me.

I had a kid suddenly pop up with c-diff symptoms yesterday. Nobody else on the unit has it. But he is tube-fed and been on abx forever, so he's at high risk according to the lit. (I'm not exactly sure why tube-feeding is a contributing factor, either). I was just wondering in my confused, tired state last night, where he would have gotten it. Asking myself if I did something wrong, etc. I'm also thinking that the fact that toddlers sometimes end up on the (disgusting) floor is a contributing factor.

I sent stool and I'll be interested to see how it comes back.

breaktime · Aug 24, 2009

This is a little off-topic, but it's a related matter I think...Sasha brings up a good point that we need to remember to take precautions at home like not wearing our work shoes in the house, or hanging out at home in our scrubs after work, etc. Of course if you wear your shoes out of the hospital and get in your car, now it's on your floor mat and could get on another pair of shoes. However I don't go so far as leaving my shoes at the hospital (especially since I'm still a student and have nowhere to keep them). I think you have to decide what level of risk is acceptable for you, and your family and take precautions based on that. With that in mind, thanks to the OP for bringing this topic up, one more thing I now know how to protect my family against.

*ac* · Aug 24, 2009

This is from MayClinic.com
C. difficile bacteria can be found throughout the environment-in soil, air, water, and human and animal feces. A small number of healthy people naturally carry the bacteria in their large intestine. But C. difficile is most common in hospitals and other health care facilities, where a much higher percentage of people carry the bacteria.
C. difficile bacteria are passed in feces and spread to food, surfaces and objects when people who are infected don't wash their hands thoroughly. The bacteria produce hardy spores that can persist in a room for weeks or months. If you touch a surface contaminated with C. difficile, you may then unknowingly ingest the bacteria.
People in good health don't usually get sick from C. difficile. Your intestines contain millions of bacteria, many of which help protect your body from infection. But when you take an antibiotic to treat an infection, the drug can destroy some of the normal, helpful bacteria as well as the bacteria causing the illness. Without enough healthy bacteria, C. difficile can quickly grow out of control. The antibiotics that most often lead to C. difficile infections include fluoroquinolones, cephalosporins, clindamycin and penicillins.
Once established, C. difficile can produce toxins that attack the lining of the intestine. The toxins destroy cells and produce patches (plaques) of inflammatory cells and decaying cellular debris inside the colon.
An aggressive strain of C. difficile has emerged that produces far more deadly toxins than other strains do. The new strain is more resistant to certain medications and has shown up in people who haven't been in the hospital or taken antibiotics. This strain of C. difficile has caused several outbreaks of illness since 2000.
http://mayoclinic.com/health/c-difficile/DS00736/DSECTION=causes
The above pretty much is just a rewording and confirmation of what SweetOldWorld said, but I thought it might be helpful.

Helpful article! I actually read this last night, but was too dang exhausted to really comprehend it.