Clostridrum Difficile Infections: Increased Threat
Monday, September 22, 2008
JC Jones MA RN
C. difficile or CDAD (Clostridium difficile associated diseases) are gastrointestinal infections caused by an anaerobic bacterium and usually acquired by people who are already sick and often in a health care facility. Symptoms can range from mild, watery diarrhea along with fever, abdominal pain and loss of appetite to life-threatening complications like toxic megacolon, sepsis, pseudomembranous colitis and can be fatal. Being on antibiotics (either prior to exposure to the bacterium or approximately the same time as exposure, which wipe out the normal intestinal flora, is a major risk factor for this infectious disease. The bacteria are found in the feces. A stool sample will be needed to confirm the diagnosis.
The CDC reports that the scenario for acquisition is usually:
- patient with advanced age and underlying illness
- colonic microflora disturbed (usually due to antibiotic use)
- acquisition of C. difficile
- the incubation period is unknown at this time
There are half a million cases of C. difficile in the US each year, up from 150, 000 cases in 2001. The infection may be responsible for as many as 30,000 US deaths each year. The number may be higher as it is not yet a reportable disease. Hands and surfaces contaminated with feces spread the disease. Recent outbreaks of an epidemic strain indicate increased virulence and antibiotic resistance. More people are affected by the disease, and more are showing severe symptoms. Like MRSA, C. difficile is now being seen in what used to be considered "low risk" populations - healthy people in the community (CA-CDI) and pregnant women. The mortality rates have risen from 6 deaths per million in 1999 to 24 deaths per million in 2004.
Long term care facilities are particularly vulnerable and it is important for the general public to know that infections can occur from contact with contaminated environmental surfaces. 10% bleach is known to be an effective agent against C. difficile. Alcohol gel and antiseptic hand wipes are NOT as effective as good old-fashioned water and soap at removing C. difficile from the hands. Of note - skin contamination with C. difficile continued for as long as 1o days after diarrhea stopped, so that is the rationale for continued isolation of a contaminated patient who is no longer symptomatic.
The CDC is investigating a possible food-borne transmission link as C. difficile is a pathogen of calves and piglets, and has been isolated from retail meat products. Transmission from animals to humans is circumstantial at this point.
- Wash your hands before eating and after using the bathroom.
- Clean surfaces in the bathroom and kitchen and patient care areas with 10% bleach.
- Clorox and Safeway manufacture Disinfecting Wipes that are easy to use for decontaminating surfaces. They can be purchased in On The Go packs for taking with you to restaurants or other places where you may be exposed to contaminants. If you are visiting a loved one in a facility, you may want to consider packing your own disposable gloves and decontaminating the call bell, hand rails and other surfaces.
- Health care professionals are known to spread infections. Don't be embarrassed to insist that anyone wash their hands before having contact with you or your loved ones.
Thank you vjmari's photos for use of image.
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Big Thanks to RNCentral.com for Top 50 Health 2.0 Blogs!
Friday, September 19, 2008
JC Jones MA RN
RNCentral.com honored Healthline's Health Experts network of bloggers in their Top 50 Health 2.0 Blogs.We are really happy to be recognized along with many of our friends in the blogging community. Thank you!
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Pine Bark Extract May Reduce Osteoarthritis Symptoms
Wednesday, September 17, 2008
JC Jones MA RN
I wrote an earlier post about the benefits of Pycnogenol -
Pycnogenol Helps Relieve Menstrual Pain. A new clinical trial indicates the
pine bark extract helps reduce the symptoms of osteoarthritis (OA). Over one third of adults over age 65 years have symptoms of OA (pain and limited joint movement). Three clinical trials have reported positive results for use of pine bark in reducing the pain associated with OA. Pycnogenol has powerful anti-inflammatory, and given its history of long-acting relief, may actually rebuild joint function. It does not irritate the gastric system as do NSAIDS. If you have bleeding or clotting problems, or are using anti-coagulants, discuss use of Pycnogenol with your doctor.
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48 US Deaths due to Hurricane Ike so Far: 4 Year Old Boy Succumbs to Carbon Monoxide
Monday, September 15, 2008
JC Jones MA RN
As search and rescue teams make their way through the swath of devastation left by Hurricane Ike, the death count is rising. One fatality is a four year old boy who died of carbon monoxide (CO) poisoning from a generator inside the home. The rest of the family is being treated for CO poisoning. Generators are a convenience to keep appliances running during power outages, but they must be used safely. Follow these guidelines for safe generator use:- During installation, turn off the main circuit breaker in the house and install the generator on the main circuit breaker only so that power lines are not energized. Failure to do so could injure or electrocute service personnel working on what are expected to be de-energized lines.
- Use the generator in a well-ventilated area - preferably outdoors to eliminate the possibility of CO poisoning.
- Turn off the generator to refuel it to minimize the risk of fire.
- Use heavy duty extension cords in good condition intended for use with a generator to power appliances.
Anything that burns fuel can cause CO poisoning. When fuel is burned incompletely or inefficiently, undetectable CO gas is a by-product. CO monitors are relatively inexpensive and easy to install in the home. Get yours today - one for each story of your home or business. Thousands of people die each year from this preventable, accidental poisoning. Signs and symptoms of CO poisoning?:
- Headache
- Drowsiness
- Dizziness
- Fatigue
- Nausea
- Blue lips
If you are inside an area where CO poisoning could be an issue - get out of doors immediately and get emergency medical treatment.
Thank you Coast Guard Newsstream for use of photo of Galveston TX Post Hurricane Ike.
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Violence Prevention in the Wake of Disaster
Friday, September 12, 2008
JC Jones MA RN
Hurricane season is stressful to everyone and the disruptions in routine, unexpected expenses and loss of income are especially difficult for those who are evacuated, or whose homes are damaged by storms. The CDC offers these tips for those affected by natural disasters:
- Keep your children safe and remain a caring parent: kids get their cues about how to respond to emergencies from their parents. Focus on comforting them and providing care and shelter for them.
- Get help from family and friends: when you need a break due to the stress you are under.
- If you see someone who is being violent: take action to remove the targeted person from danger and report the matter to authorities.
- Avoid use of drugs and alcohol: to relieve stress - relaxed inhibitions will make you a more vulnerable target or may cause you to lash out at others.
- Prevent suicide: by staying active and staying in touch with others. The National Suicide Prevention Hotline: (1-800-273-8255)
Reach out to others in your community and work together to get through the tough times. Thank you Radio Nederland for use of photo of Haiti hit by Hurricane Ike.
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Measles & Mumps on the Rise in the US Again: Are Vaccines Safe?
Wednesday, September 10, 2008
JC Jones MA RN
The CDC reported 131 new cases of measles in the first seven months of 2008, none resulting in deaths but 15 resulting in hospitalizations. Despite a call for booster shots for mumps vaccine in the 1990's, with a goal of elimination of the disease by 2010, the US had an outbreak of 6584 mumps cases in 2006. 85% of the cases were in eight contiguous midwestern states, 85 hospitalizations and no deaths, and 76% of the cases occurred between March and May 2006.
The US Supreme Court mandated the states' right to mandate immunization in 1905. Almost every child in the US receives the MMR vaccine in the first year of life and a booster shot before entering school. Most public schools require proof of vaccination, yet some parents elect to opt out of the practice. They may then choose to home school their children. A rift in the social fabric - both in the US and UK - has developed between the individual's right to choose and responsibilities to the social community. Parents who opt out of vaccination have come to the conclusion that MMR vaccine and the rise in childhood autism are linked. A recent study [Hornig M, Briese T, Buie T, Bauman ML, Lauwers G, et al. 2008 Lack of Association between Measles Virus Vaccine and Autism with Enteropathy: A Case-Control Study. PLoS ONE 3(9): e3140 doi:10.1371/journal.pone.0003140 ]
finds no association between the two. Today a UK doctor, Andrew Wakefield, faces professional misconduct charges for raising concerns about the safety of the MMR vaccine. Multiple studies have been done and no association has been proven between the vaccine and autism.
But that does not assuage the doubts and fears of parents - many of whom are mistrustful of government intrusions into decisions about their childrens' healthcare - and an increasing number of required or recommended vaccines. As many as 28 injections to protect against 14 different diseases are now required or recommended in the US. Many are skeptical of pharmaceutical company profits and are uneasy about the relationship of pharma, legislators and providers who drive immunizations and profit by them.
As immunization rates drop, outbreaks can occur in vulnerable populations. Measles and mumps can be deadly. If you have concerns about vaccine safety and have opted out of vaccinating your kids with MMR, be sure to discuss your fears and concerns with your health care provider this month.
Thank you ninjapoodle for use of photo Because you can never know too much about Shingles...
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So You Think You Want to Volunteer as a Disaster Responder?
Monday, September 08, 2008
JC Jones MA RN
That is wonderful news to the people who need help, but organizations like the National Institute for Occupational Safety and Health (NIOSH) want you to be prepared. Flood waters are often contaminated with sewage, chemicals, and pesticides; physical hazards may be submerged or floating and displaced animals, reptiles and even insects represent dangers to the relief worker. It is important to be equipped with the right personal protection equipment (PPE) and clothing to protect yourself from hazards of the job. NIOSH recommends:
- Electrically insulated, waterproof boots with a steel shank toe and insole. Sneakers are not acceptable as they transfer contamination and do not protect against puncture, bites or crush injuries. Hip waders offer further protection against contaminated floodwaters.
- Safety glasses with face shields
- Protective head gear - a hardhat may be required in some settings
- Hearing protection
- Heavy, waterproof cut-resistant gloves
- Long pants and long-sleeved shirts or coveralls
- NIOSH approved respirators (breathing protection) may be required in some circumstances
Other recommendations: wash hands with soap and clean water before eating and drinking. Drink bottled water and take frequent rest breaks. Use insect repellent and sun block. Wear waterproof gloves and dressings to protect any open abrasions or wounds.
Be Prepared: Call your local Fire Department and sign up for Certified Emergency Response Team (CERT) training in your community today. Children as young as 14 years old may participate with an adult. This activity will serve as the required Community Service hours for Middle and High School students.
Thank you soldiersmediacenter for use of photo Iowa Flood 2008
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Surgery for Parkinson's Disease Symptoms
Friday, September 05, 2008
JC Jones MA RN
A jury in Kentucky awarded $5 million to the widow of a man who died following elective surgery for Parkinson's disease symptoms. While most of us are familiar with Parkinson's disease as a chronic illness manifesting in tremors, many people are unaware that there are surgical options available for treatment. Surgical treatment for Parkinson's disease symptoms actually predated medical treatment. At the beginning of the last century, ablation of the sensorimotor cortex was performed, and later, experimentation and exploration of the basal ganglia and extrapyramidal system were tried, but the mortality rate was unacceptably high. Levodopa was introduced in 1968, but hopes that this medication would be the definitive treatment were diminished as patients became refractory to the drug or developed side effects that were worse than the symptoms (dyskinesias, motor problems).
Normal movement is initiated by neurons in the cerebral cortex and modulated by nerve cells in the basal ganglia and thalamus. Too much output from the basal ganglia leads to decreased and slow motor activity seen in Parkinson's disease - rigidity, tremor, instability and moving slowly. Goals of surgery are to either reduce thalamic activity (ablation) to restore balance or increase neural activity of other brain targets. Neurologists and neurosurgeons treat this complex problem. Some of the methods in use today are:
- Pallidotomy: destruction of a small region of the brain. A type of ablation treatment with a high risk of dysarthria, dysphagia and dysphonia.
- Deep Brain Stimulation (DBS): electrodes are surgically implanted into the subthalamic nucleus (STN). Programming the stimulator is complex, requiring extensive follow-up and battery replacement. Patient selection criteria is stringent.
- Transplantation: still in experimental stage, researchers are investigating the use of stem cells. New cells taking over the function of old cells may be the only hope for a cure.
With careful patient selection, morbidity and mortality rates are relatively low - less than 8%. As with any medical procedure, even elective surgeries and especially those involving such a delicate and complex structure as the brain, there are risks. Make sure you and your loved ones understand the risks associated with any elective procedure before you agree to have it done, and seek a second opinion if you are uneasy or have further questions.
Thank you Nieve44/La Luz for use of photo My father has Parkinson's.
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What Would YOU Do in a Disaster?
Wednesday, September 03, 2008
JC Jones MA RN
Amanda Riley, author of The Unthinkable, and reporter for TIME has dedicated her career to understanding how humans respond to disasters and how to improve our chances of surviving a disaster by changing our behavior. Ripley's investigations of how humans respond to disasters like the WTC collapses or the New Orleans floods have yielded surprising results - most humans become docile in the face of catastrophe. She finds that we humans move slowly and become kinder to one another as if walking in a dream.
Ripley has interviewed researchers around the world who have learned that since most people live their entire lives without facing disaster, when catastrophe strikes, they are stunned into a state of disbelief. "This can't be happening to me," which makes responses slow and apparently overrides the "fight or flight" response one would think would kick in. When given clear orders to evacuate, most people engage in a behavior called milling - gathering the opinions of at least three other sources before actually following the instructions to leave. Women respond more quickly than men do.
The weird thing is that people have been found to have a different "disaster personality" from their everyday persona. The commanding business leader may be the person who freaks out and obstructs the evacuation process. A neurotic worrier may become a calm leader. Only 15% of people actually remain calm and respond efficiently to true disasters, another 15% might freak out and hinder the process, while the remaining 70% of people do next to nothing simply because they are confused and dazed. Survivors of disasters report feeling like "a zombie". They report witnessing others die simply because they were unable to move.
Psychologists call this process of shutting down in the face of danger "freezing behavior". Rape victims have reported similar behavior and it may be a primitive survival instinct since many predators will not eat prey that does not struggle. To increase your chances of surviving any situation, Ripley recommends always familiarizing yourself with exits and mentally preparing an exit strategy. The sad truth is, people behave like goats, expecting to be led and told what to do. To increase your chances of surviving the unexpected, mentally prepare yourself to make decisions, fend for yourself and lead your loved ones to safety.
Thank you Rendy Maulauna for use of photo Tsunami Victims Evacuation, Bali.
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Thank You Laurie Edwards at Chronic Dose for Grand Rounds Vol. 4 No. 50
Tuesday, September 02, 2008
JC Jones MA RN
Author/blogger
Laurie Edwards at Chronic Dose hosted Getting Educated Medical Grand Rounds this week. Thanks for including my post
Have the Olympics Inspired You to New Fitness Greatness? in this delightful edition of Grand Rounds.
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