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A Super-Bug of Increasing Concern

Posted Jan 14 2009 7:45pm

Hand hygiene is in the news again, this time as part of the antidote for the much bigger news story, the nasty gut bug Clostridium difficile (C. diff). Largely hospital acquired, C. diff is virulent, difficult to treat and it can be deadly. The most toxic strain of the organism, which can produce up to 20 times the level of toxins than less benign strains, are drug resistant and respond to only the most powerful antibiotics, putting it second only to the super-bug MRSA in difficulty of treatment. The elderly and debilitated are most at risk from the effects of C. diff, ranging from severe diarrhea and colitis to blood poisoning and death.

The Centers for Disease Control and Prevention (CDC) estimates that 13 in every 1,000 hospital admissions become infected with C. diff. That doesn’t seem like many, does it? It didn’t seem so to me initially, but I suspect I am simply so provincial that I have trouble seeing the big picture beyond my relatively small community. Therefore, it wasn’t until I saw those numbers taken to the next level that the enormity of the danger became apparent to me. The cold, hard statistics are that 13 in every 1,000 patients equals 7,000 infections and 300 deaths on any single day, nationwide.

Even more shocking are the numbers that result when C. diff infections extend a patient’s hospital stay and increase the cost of care. If the number of infections reported in a recent survey were extrapolated to all hospitals in the U.S. on a single day, those patients would tally more than $32 million in costs, on average, and an astounding 40,000 extra days of hospitalization.

Inadequately cleaned surfaces are the major culprits in the spread of C. diff. The pathogen’s hard-to-kill spores are transmitted in feces. Infection occurs when people ingest the spores, most often by touching surfaces and then touching their mouths. Contaminated food can also be a source of contact.

Prevention of this potentially fatal infection involves teamwork. Hospital employees at all levels need to be more diligent than ever regarding environmental hygiene. Sanitizing hands and equipment must be priorities. The usual hospital disinfectants are not effective in killing C. diff. A strong bleach solution is required to eradicate C. diff spores and should be used to clean all surfaces and equipment. It would be good to follow the lead of one chief of infection control at a large metropolitan hospital, who reports that rooms in his facility are inspected with as much rigor, if not more, than is the kitchen.

Patients and families need to do their part, too. They need to avoid asking for antibiotics indiscriminately (and doctors need not to cave in to patients’ demands), so that C. diff does not build up further immunity to antibiotic treatment. It should be emphasized that hand hygiene is as important for the lay public as for caregivers. Patients and families need to know that it is acceptable to question any and all caregivers as to whether equipment and hands have been properly sanitized.

Imparting this information to patients, family members and fellow employees presents a teaching opportunity—or necessity—for nurses. I know, we have enough to do without dealing with another opportunity, but we have to engage our patients anyway, so conversation can employ teaching and vice versa.

Has C. diff been a problem in your workplace? How is it dealt with?

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