C. diff: More Dangerous than You Think
By CareerSmart Learning Contributor, July 25, 2016, as published by Healthcare Hot Spot
Clostridium difficile, otherwise referred to as C. diff, is a known and rampant problem in all health care facilities as well as in the community- but the gravity of C. diff is often ignored. In 2011, the Centers for Disease Control and Prevention (CDC) reported that approximately 29,000 people died within 30 days as a direct result of C. diff infection (CDC, 2015).
C. diff is a bacterium that invades the intestinal tract, causing inflammation of the bowel and resulting in severe diarrhea that can lead to life-threatening complications, such as severe dehydration, sepsis, toxic megacolon, or bowel perforation. The risk of developing a C. diff infection is more common, especially after extensive antibiotic use, which can make patients more susceptible to the infection. Early recognition of the main clinical symptoms of C. diff infections by caregivers and reporting these symptoms to healthcare providers is important. Common early symptoms include watery diarrhea, abdominal cramp or tenderness, loss of appetite, nausea, and malaise. Fever may also be present in severe cases.
Patients with immunocompromising conditions and the older adult population over the age of 65 are at increased risk of developing a C. diff infection. In 2011, approximately 453,000 people were infected with C. diff. About one-third of those C. diff infections were community associated (contracted outside of a healthcare setting or present on admission). Over 300,000 C. diff infections in that year were healthcare associated (developed during the course of receiving or following treatment). Of those healthcare associated C. diff infections, about 200,000 of those infections occurred in people over the age of 65. In total, 15,000 deaths were directly caused by a C. diff infection, community or healthcare acquired. It is vital to understand that 12,000 of those deaths were in people over age 65 (Whiteman, 2015). The older adult population is apparently disproportionately affected by C. diff in the healthcare setting, especially those in long-term care facilities where the infection can easily spread.
C. diff spores are capable of surviving outside the human body for a very long time and can be found in the environment, such as on high-touch surface areas. The infection can easily spread from person-to-person. Appropriate medical intervention and adherence of regulatory guidelines on infection control must be enforced. Staff, family, and visitor education regarding the disease and emphasis on prevention of spreading the infection (such as hand hygiene) is critical. Protocols on contact precaution and recommended environmental disinfection strategies should be exercised as a daily routine.
While antibiotics kill or inhibit bacterial infections in people, antibiotics also kill the good organisms in the gut. Without the good organisms in the gut to maintain homeostasis, a C. diff spore is able to invade and proliferate, making patients vulnerable to C. diff infection. Because of this, decreasing inappropriate antibiotic use is key. In the healthcare setting, broad-spectrum antibiotics are widely used before the specific bacterium is actually known. In that instance, sometimes an incorrect antibiotic is used because the bacterium was wrongly assumed, or none was even needed in the first place. Research has found that 30-50% of antibiotics prescribed in hospitals are either incorrect or unnecessary (Whiteman, 2015).
Hospitals are adopting antibiotic stewardship programs to ensure that antibiotics are correctly utilized, both the type of antibiotic and the duration of treatment. One study found that decreasing antibiotic use in hospitals by only 10% led to a 34% reduction in C. diff infections (Whiteman, 2015). Along with recognizing early symptoms of C. diff and practicing infection control, all healthcare workers can also advocate correct use of antibiotics for their patients as decreasing C. diff infections by more than one-third can save lives.
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Whiteman, H. (2015). Half a million C. diff infections and 15,000 deaths in 1 year. Medical News Today. Retrieved on 9/11/16 from http://www.medicalnewstoday.com/articles/290034.php
CDC (Centers for Disease Control). Healthcare-associated Infections-Clostridium Difficile. Retrieved on 9/16/16 from http://www.cdc.gov/HAI/organisms/cdiff/Cdiff_clinicians.html