Exposure to C. Diff
We had two emergency runs tonight, which means that there was one less call from last week. Last week we had three runs, each with 20 minutes of downtime in between, just enough time to catch your breath and remove your shoes, but not much else. They were, surprisingly, all medical calls and all emergent... So often we are taking completely non-emergent patients (much like call #2 tonight).
Tonight's call #1 was over on Califon Drive, on the other side of town (this is normally Car 65's area, but their primary rig was out and had only one person respond to the backup call. He remained onscene in his personal vehicle and helped us when we showed up, but it was our call.) The patient, an elderly lady who fell while attempting to go to the bathroom, conveniently fell into the bathtub... I'm not sure how that was convenient or to whom, since it took the collaborative efforts of all of us to get her extricated safely from said tub.
The husband mention a history of Alzheimers, blood pressure, but no mention - none - of C.Diff. Here's the skinny on C.Diff:
What is C. diff?
C. diff is a microorganism that is one of the many bacterial organisms normally found in the gastrointestinal (GI) tract. There are many such bacteria that are normally present in the body; they aid in digestion and absorption of food and nutrients. C. diff is present as normal GI flora in about three percent of all healthy adults and about 10 to 30 percent of hospitalized or chronically ill patients.
If C-diff Is a normal GI flora, why does it make people sick?
C-diff usually is not harmful in the patients that have it in their GI tract. However, under certain circumstances, C-diff can grow out of control in the GI tract. This overgrowth of C-diff produces toxins within the GI tract that result in severe infectious diarrhea and inflammation of the large intestine (colitis). It is when these things occur that C. diff goes from normal, harmless GI flora to dangerous infectious organism. In fact, C. diff is the most common cause of hospital-associated diarrhea.
Why Does C-diff Overgrow?
In the GI tract, there can be “good” bacteria and “bad” bacteria. Good bacteria assists in digestion and the absorption of nutrients but also helps control the growth of “bad” bacteria. In other words, good bacteria protects the GI tract from “bad” bacteria. C-diff overgrowth occurs when the good bacteria fails to prevent the overgrowth of C. diff. This can happen for several reasons.
Antibiotic Use – We all know that antibiotics are used to kill bacteria that are causing infection somewhere in the body. At the same time, the antibiotic can kill the “good” bacteria in the GI tract, allowing the “bad” bacteria such as C. diff to grow unchecked, producing the toxins that cause severe diarrhea. Some estimates say that about 90 percent of all health care associated C. diff is related to broad spectrum antibiotic use.
Anti-ulcer Medications – Anti-ulcer medications decrease the acidity of the stomach which in turn prevents gastric reflux and ulcer formation. However, altering the acidity of the stomach and GI tract can kill off “good” bacteria, allowing C-diff to grow out of control. In addition, altering the acidity of the GI tract can create an environment that is perfect for “bad” bacteria such as C-diff to grow unchecked.
Long Hospital Stays – A combination stress from illness, weakness from laying around in a hospital, and the potential for C-diff contamination from patient to patient makes extended hospital stays a risk factor for C. diff infection. In fact, C. diff infections within hospitals is a major problem for all infection control departments. Special isolation procedures are in place to limit the spread of C. diff from patient to patient via health care workers.
Underlying Chronic and Acute Illness – As mentioned earlier, acute and chronic illness can weaken a body’s defenses, making it more susceptible to C. diff infection.
Age – Like many infectious illnesses, people older than 65 years of age seem to be more at risk for C. diff. In addition, younger children and infants are also at a greater risk. Most likely, the risk is greater in these age groups due to weak or immature immune systems that are unable to fight a C. diff infection.
Immune System Suppression – Chronic diseases like HIV and cancer that are characterized by suppressed or weakened immune systems have proven to increase the risk of C. diff.
How Does C. diff Spread?
C. diff is present in the stool of infected people. It forms spores that can be transferred by direct contact to toilets, bed rails, towel racks, etc. People can also spread the spores from hand to mouth when coming in contact with contaminated surfaces. C. diff spores can live and infect up to 5 months on environmental surfaces. Unfortunately, C. diff spores are not killed by traditional disinfectants used by hospitals when cleaning. Chlorine bleach at a concentration of 1:10 is the only agent that effectively kills C. diff spores on environmental surfaces.
What are the Symptoms of C. diff Infection?
There are three primary symptoms of C. diff infection: watery diarrhea that may contain blood or pus; fever; abdominal pain, cramping or tenderness
Do I have any expectations of coming down with this, as I wore the appropriate gloves and did what I should have done? No, I really don't. Still... had we known, we could have deconned immediately and also warned the three officers onscene and dispatch and Chris from Car 65. Not to mention, at 2340, this is less than ideal. I was dog-tired and wanted to go home and back to my nice warm bed! The one I'd been dragged from kicking and screaming while asleep. That bed!
Groan.
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CLOSTRIDIUM DIFFICILE
What Is Clostridium difficile?
Clostridium difficile is a spore forming bacteria that has been associated with outbreaks of diarrhea and colitis in hospital patients and long term care facility residents. Almost all patients at greater risk of acquiring Clostridium difficile diarrhea are elderly or have other illnesses or conditions requiring prolonged use of antibiotics.
Symptoms and Duration:
Watery diarrhea is the most common symptom, but abdominal pain, fever, loss of appetite, nausea and abdominal pain may also occur. Some patients may be asymptomatic until exposed to antibiotic treatment.
Incubation Period:
There is no incubation period. People in good health usually don’t get Clostridium difficile disease, only people that are hospitalized or on antibiotics are most likely to become ill.
Recovery, Long Term Effects & Immunity:
In the majority of patients, the illness is mild and full recovery is usual, although, elderly patients may become seriously ill with dehydration as a consequence of diarrhea. Treatment is not recommended if there are no symptoms. In people with mild diarrhea, stopping the use of antibiotics together with fluid replacement usually results in rapid improvement. Sometimes, however, it is necessary to give specific therapy against Clostridium Difficile itself.
How Is Clostridium difficile Spread?
People with C. difficile infections carry the bacteria in their intestines. The bacteria produce a spore, which is shed in the feces of an infected person. The bacteria can be passed from person to person through direct contact, environmental contamination (bedding, commodes, bedpans, sinks, anal thermometers, handrails, etc) and can be carried on the hands of health care workers as they move from patient to patient. The spore can survive in the environment for up to 70 days. They prefer to live in dry, dusty areas.
How Do You Prevent Clostridium difficile Infection?
• Thorough hand washing is the best prevention. Hands should be washed after handling contaminated waste (including diapers) and prior to eating, feeding, or providing personal care.
• Follow enteric precautions with known cases of C. difficile in health care facilities to limit the spread of the illness to others.
Hi my name is BETH:
I have found your BLOG because I recently was a British Columbia, Canada - victim of C diff and I've placed a www.google.com search on any Internet articles that are published on C diff, so I was mailed your blog tonight.
I have done massive amounts of research since I was first diagnosed with C diff this past September 2007, as I needed to understand what this 'disease' was all about. It almost killed me, so when I had periods I could function, I researched ..
I am a young 47 years old and was healthy until end of July 07 – when I decided to go for a mammogram which came out abnormal. My doctor rushed me in for a core biopsy to be done. Once completed it came back positive for cancer so an excisional biopsy was then scheduled. Near end of Aug-07, I ended up with pneumonia so my doctor treated me with a two week course with the antibiotic Ciprofloxacin.
I diligently took these antibiotics so I would be well enough for my excisional biopsy.
On Sept 24th-07, I had my excisional biopsy and then returned to my home town of Merritt BC.
Within three days I was running fever and things just went from hell to the hand basket.
My breast incision became infected and I was put onto 5-day (outpatient) intravenous antibiotics for the infection.
Oct 4th-07 – I was so ill, running fever, vetogo, vomiting with severe watery diarrhea that contained intestinal casings and blood.
On Oct 7th I was diagnosed with C diff. I can barely remember the next four weeks. I fought dehydration and my white blood count was way out of whack. My electrolyte balances were affected; my potassium and sodium counts were out of whack. Thank god for my husband's care for me and carrying me up to the hospital.
After the C diff diagnose, my doctor explained the IMPORTANCE of taking probiotics, while taking antibiotics.
I WISH he would have told me that while I was taking the antibiotics, (any time ANYone takes any antibiotics) instead of AFTER contracting the C diff.
I was prescribed Flagyl (the most common treatment) and liquid Vancomycin antibiotics, stronger and more effective, against the more resistant strain of C diff, which I had.
My doctor started to panic and wanted to admit me back into hospital but from my research I told him NO. He asked me why as he said, people are dying from this!? He told me two people died within our health area in the last two days.
I told him I believe I got this infection while in hospital. And I didn't think the hospital had the budget to give me the flexible care I needed. (which I would get at home) He says he thinks I got it from talking the antibiotics.
I wasn’t up to arguing and how could this ever be confirmed? But I told him IF I was going to die, it was going to be at home. I went home and my family starting bleaching our house. I was in bed for endless time, my husband bought spray bottles but we bleached the kitchen or bathroom every time I walked into these rooms, (anytime I touched anything) - (in fear I would infect my family) using 10/1 water / bleach concentrate, light switches, door(s) knobs, walls, floors, (bedding bleached), all hard surfaces in the house.
Then I had a friend contacted a nature pathic who sent instructions for me to massively take probiotics. The probiotics are loaded with LIVE GOOD bacteria that will FLUSH the bad flora bacteria (C diff ) from my digestive track. I was told you cannot over-dose on GOOD (flora) Live bacteria but you can die from over-load of bad flora bacteria.(C diff)
I won’t publish my list of probiotics that did work for me, but if anyone wishes to know – Please ASK...
My husband went to the health food store and he told the health food store staff what I had. (They confirmed what the nature pathic recommeneded)
They recommended four different products that we bought by the case(s) and after getting approval from my doctor (who was quite impressed) I started to take these LIVE probotics in-between taking my antibiotics.
I couldn’t eat food for almost ten+ weeks. Yogurt & probiotics were my diet. My stomach would not hold food or digest anything and I had severe bloat. I would violently throw up. I found it a challenge to take the probiotics as they had to be taken 3 hours before or 1 hour before each antibiotic dose. When I first started taking the probiotics it created a war inside me, which I wasn’t sure I was going to WIN.
I was in constant contact with my doctor, (If I didn't call him, they were calling me) and I had to attend the hospital to receive IV for fluids as the C diff bacteria was stripping it all from my body when I ingested fluids. Oral fluids such as water and electrolyte replacement solutions were necessary. I had to spend the occasional (6) nights in hospital due to dehydration, but I was very careful about what I touched or who touched me.
I requested the hospital staff in the hospital to use gloves (for their protection and MINE) as none of them seemed concerned about contracting C diff, or spreading the spores to other patients.
Thursday night - I was concerned one night while I was in hospital for IV, as I was feeling so deathly ill, while I was in the Emergency room full of elderly person(s). I asked the nurse if I should be using a different ‘bathroom’ like one that was separate from the one everyone else was using.
The nurse told me oh no, everyone here has to use the same one.
Having C diff, I had no choice but to use the bathroom ( 3 times) during my hour & half IV treatment and the bathroom was the same the PUBLIC used, as well as everyone else from the Emergency ward.
The first time I went into the bathroom there was vomit in the sink, no toilet paper, there was ‘wet liquid’ of some type in front of the toilet and paper towel had been used (instead of toilet paper) and it was over flowing from the garbage can and onto the floor. Hence: the cleanliness of the bathroom concerned me greatly.
I pushed my IV pole back to my ER bed and layed there, for the rest of my IV treatment.
Then a patient was brought in from Kamloops. He was transferred in by ambulance. He had a lady with him that did most of the talking to the nurse and doctor. I layed there and listened as my IV re-hydrated me. This poor man was so out of it he couldn’t understand or speak. The lady with him explained to the doctor that he had had bowel surgery at Kamloops Royal Inland Hospital two days before (on Tuesday) and this was Thursday night.
This unconscious male patient had surgery on Tuesday and after surgery they didn’t have a room for him so they kept him in the hallway until she (lady friend or sister) complained about it and then Royal Inland sent him back to our Merritt hospital.
The Merritt nurse tried to talk to this patient and he was not
understandable. The doctor came and tried to talk to him and he was incoherent. The lady that was with him ( was a friend, or sister) explained to the doctor that he had bowel surgery and the situation of him not having a room after his surgery and that he was kept in the hallway. She said the Royal Inland Hospital transferred him because she "was getting loud" that he was not in a room. She then went on to tell the doctor he had not had a bowel moment since his bowel surgery and she was concerned about that. The Merritt ER doctor asked a few more questions then ‘the lady’ told the doctor that the patient had some bleeding from his rectum. She said she had been told this by Royal Inland staff.
The doctor instructed the nurses to get the patient up and take him to the bathroom, to see if he could have a bowel movement.
I lay in my bed across from him & I started to reel and FELT like screaming NO, no .... I just used that bathroom and I’m infectious.
But I didn’t – and I have felt guilty ever since.
I did though make a complaint to the Infectious Disease Control (CDC) in Kamloops BC the next day.
I told them this entire story and that I felt very bad as this poor man was very likely to have become infected by me.
Please remember I was very sick and this was also the same nurse that told me to use that bathroom, then took that poor man to sit where I had sat three times with severe C diff diarrhea.
Kamloops CDC told me that Interior Health has very high standards of cleanliness and I told her bullshit!
• I have seen blood pressure cuffs used on me and then taken and used on the next patient.
• I have seen my used IV pole disconnected from me and pushed back into the available equipment line-up.
• I explained about the bathroom conditions.
• The CDC specialist told me that there would be no way that they would do this and I corrected her AS I was there! She wasn’t and I’ve seen this several times while I have been treated for C Diff.
I lived thought being diagnosed with C diff, and was horrified when I realized what Clostridium difficile, or C. Diff was, probably just as you are worried.
I have researched and researched & do feel I have great understanding of this disease. Even when I spoke to the CDC specialist she said they maximized on their budget with “Wash Your Hands” posters. I said NOT good enough – it needs to be explained to the PUBLIC and to people that when they enter hospitals (care homes) or as like you – EMS personal that “WHY” the need to wash your hands.
EACH and EVERYTHING that you touch or someone that touches you can be infected with contaminated species of sorts.
I am sorry my story has been so long but I’m telling you this to help you understand. Our health authorities or CDC centers (which C diff is classified as being a Infectious Disease) – they all white-wash the situation and you are not going to get the ‘truth’ from them.
As an EMS person, WEAR GLOVES like every person has HIV or C diff.
You can get C Diff – Material Safety Data Sheets information: http://www.phac-aspc.gc.ca/msds-ftss/msds36e.html
Perspectives of Health & Safety: http://www.hchsa.on.ca/products/newsltrs/sa_w2004.pdf Page 21 -
Scrub (wash) your arms, hands & face every chance you get.
Don’t wear your uniform home.
Stay away from BAR soap as anyone that is contaminated with C diff, leaves spores on that soap bar.
USE liquid hand soap, as it it cannot be contaminated by someone who may be ill or colonized with C diff without knowing so.
The only way that you would be able to become infected by a person that did have C diff, was if you touched their feces or an area that contained their feces and then ingested it.
(STOP putting your hands in your mouth, at all times)
Most victims of C diff unknowing ingest the bacteria. Such as IF a C diff patient was in hospital and a hospital cuff (blood pressure machine) was used and then that same cuff was used on another patient. A person infected with C diff does shed C diff spores and the next patient then has that cuff wrapped around their arm – once the blood pressure cuff is measured and removed – that person might scratch their arm and then wipe their mouth. IT’s that EASY to spread the bacteria but the CDC and hospital authorities don’t want to let the public know that because it would cause public PANIC.
I’ve read the articles.
Use www.google.com to search NEWS articles just as I have and it will verify what I am saying.
I will say that I have lived through my challenge with C diff and my husband has slept in the same bed as me and he has not become contaminated to our knowledge. We washed and bleached bedding daily while I was very sick.
(Not everyone might have this hygiene though) He is not sick.
AND - It’s hard to say regardless of our efforts, he might have colonized with the bacteria but to this point:
# 1 - My husband (and grandkids) have been well
# 2 - He has not used any antibiotics
# 3 - In case of Illness, Oil of Oregano is natural instead of consuming prescription antibiotics.
# 4 - If he did need to use even Oil of Oregano, he (I) would USE probiotics in-between each dose just to prevent the bad bacteria from over-taking the good flora.
My doctor has been great and very supportive of the natural products I have taken, through this entire ordeal, and I keep researching about C diff.
I have found much conflicting information about C diff and when I say conflicting it is more in the sense of what the hospitals, agencies and government wants us to know (OR not know) about it.
When I first starting researching, I was trying to figure out how I was infected.
But my Drive is to --> EDUCATE, educate the public about CLOSTRIDIUM DIFFICILE or C diff
I found it very interesting there was a WHIMS sheet on C diff ...