Clostridrum Difficile Infections: Increased Threat
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.