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C-diff - The New # 1 Hospital Acquired Infection

Clostridium Difficile is a dangerous and unfortunately, common hospital acquired infection which can cause life-threatening diarrhea.  It is highly contagious and can easily be spread by hospital staff and patients in an acute care facility. 

The Journal of Infection Control reported in May of 2009 that the overall C. Difficile prevalence rate in acute care facilities was 13.1 per 1000 inpatients (94.4% infection.)1,2  This was a rate 20 times more than expected.2  The incidence in individual states varied from  zero in Hawaii to 28.88 in Rhode Island.2

The increase in incidence of C. Diff is felt to be due to increased antibiotic usage, an aging population, associated chronic disease, the emergence of strains resistant to the fluoroquinolones (cipro) and the emergence of hypervirulent strains.  Like the MRSA epidemic, there is now an emergence of a community acquired strain of C. Diff.3   Approximately 2.2% of patients will die from the infection and 1% will require a colectomy.3   If a colectomy is required, the mortality rate is approximately 33%.3 

C. Diff. is a spore forming bacteria and hard to kill.  It is resistant to alcohol and ammonium.   Bleach is the best agent to clean surfaces and hands should be washed with soap and water.  Alcohol dispensers will not kill the spores but soap and water will mechanically remove them.  Hand washing with soap and water is more effective than using alcohol-based hand rubs in removing C. Diff.4,5

Healthcare workers at the Mayo Clinic have reported that daily cleaning of hospital rooms with bleach has been reported to decrease the incidence of C. Difficile infection.6  Using similar methodology, a hospital in Lancaster, PA reduced the incidence of C. Difficile infection by 50%.

It is not known whether probiotics decrease the incidence of C. Diff.8  They do help with the prevention of antibiotic induced diarrhea.  

Finally, it is known that reducing gastric Ph and secretions with the use of H2 blockers and proton pump inhibitors increases the chances of acquiring C Diff.9 ( NEXIUM - PRILOSEC - PREVACID)

Patient Tip:  C. Difficile is not killed by alcohol rubs or swabs.  Staff need to use soap and water to mechanically remove spores, the bathroom and patient room should be cleaned with Clorox (Bleach).  It is important to clean the room with Clorox (Bleach) between patients. 


References

  1. Jarvis WR, Schlosser J, Jarvis AA, Chinn RY. National point prevalence of Clostridium difficile in US health care facility inpatients, 2008. Am J Infect Control. 2009 May;37(4):263-70. Epub 2009 Mar 10.  http://www.ncbi.nlm.nih.gov/pubmed/19278754

  2. Prevalence of C. diff in hospital patients American Medical News. June 1, 2009.   http://www.ama-assn.org/amednews/2009/06/01/prca0601.htm 

  3. Sahil Khanna and Darrell S Pardi The Growing Incidence and Severity of Clostridium Difficile Infection : Severity & Burden of Disease Expert Review of Gastroenterology and Hepatology 2010;4(4):409-416 Aug. 25, 2010. http://www.medscape.com/viewarticle/726904 

  4. Jabbar U, Leischner J, Kasper D, Gerber R, Sambol SP, Parada JP, Johnson S, Gerding DN. Effectiveness of alcohol-based hand rubs for removal of Clostridium difficile spores from hands. Infect Control Hosp Epidemiol. 2010 Jun;31(6):565-70.  http://www.ncbi.nlm.nih.gov/pubmed/20429659 

  5. Robert C. Owens Clostridium difficile-Associated Disease: The Environment Medscape General Surgery Pharmacotherapy. 2006;26(3):299-311. http://www.medscape.com/viewarticle/529165 

  6. Mayo Clinic. "C. Difficile: Intervention Drops Hospital Infection Rate by a Third." ScienceDaily 30 March 2010. 28 August 2010  http://www.sciencedaily.com/releases/2010/03/100319142658.htm

  7. Brosey L and Garrety S. Adherence Reduces C.diff Hospitals in Pursuit of Excellence. http://www.hpoe.org/case-studies/6872357931

  8. Hsu J, Abad C, Dinh M, Safdar N. Prevention of Endemic Healthcare-Associated Clostridium difficile Infection: Reviewing the Evidence. Am J Gastroenterol. 2010 Jul 6. [Epub ahead of print]   http://www.ncbi.nlm.nih.gov/pubmed/20606676 

  9. Howell MD, Novack V, Grgurich P, Soulliard D, Novack L, Pencina M, Talmor D. Iatrogenic gastric acid suppression and the risk of nosocomial Clostridium difficile infection. Arch Intern Med. 2010 May 10;170(9):784-90. http://www.ncbi.nlm.nih.gov/pubmed/20458086

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