OK, so now we know that Clostridium difficile infection (CDI), or C-diff, is a real, and growing problem. Where does this thing come from? It’s not like you see it oozing through the door. Or crashing in like a giant ogre. The thing is microscopic!

The thing is, you can’t see it. And you can’t even easily tell who has it. Don’t look for any particular symptoms in potential carriers because asymptomatic fecal carriage of C. difficile is common in healthcare facilities. A 2006 study conducted by the Cleveland Veterans Affairs Medical Center on LTC residents sheds glaring light on this idea. From July through September of that year the researchers examined the prevalence of asymptomatic carriage of both epidemic and non-epidemic strains of C. difficile. The result? A shocking 51% of 68 asymptomatic residents were carriers of toxigenic C. difficile. Asymptomatic carriers had higher percentages of skin (61% versus 19%) and environmental contamination (59% versus 24%) compared to non-carriers.

Investigators’ found that their hands were easily contaminated with spores from the skin of asymptomatic residents. Findings of this study suggest that there is potential for significant disease transmission in LTC facilities as a result of asymptomatic carriage in residents.

In addition, CDI places a substantial burden on healthcare facilities and may increase the risk of morbidity among the elderly with the potential for increased risk of mortality.10 The prevalence of infection varies and depends on the populations that are surveyed. Epidemiological studies must take into account that C. difficile produces a wide spectrum of disease, ranging from asymptomatic carriage to toxic megacolon.11

Let’s look at transmission a little more closely. Quite literally, this bug is a load of crap! CDI remains the most common cause of acute diarrheal illness in a LTC setting, with units housing the sickest residents reporting the highest incidence of CDI. Following a bout with diarrhea, the C. difficile makes it’s way out of the host’s body in the stool. From there, transmission occurs via the fecal-oral route on the hands of healthcare facility personnel. Working in healthcare, in a hospital, LTC or nursing home facility, one is acutely aware that contact with feces is not that uncommon. Still a little gross, but part of the normal work.

Hand carriage is the main means of transmission of the organism, but you don’t have to be in contact with feces for that to occur. C-diff travels well and has no difficulty in heavily contaminating the environment and any nearby inanimate objects. Including bedrails and bedside equipment. And yes, you can catch this one from a door knob or toilet seat. You see, in its spore state in particular, the organisms can live, waiting for a new host, for up to five months on surfaces in a healthcare environment. How many over-bed tables, monitors, pumps, beds, sheets, countertops, sinks, toilets and so forth and so on do you think you would come into contact with over the course of five months? Did you let your guard down anywhere along the way?

Perhaps the magnitude of this guy’s transmissibility is beginning to dawn on you now. Microscopic. Long lived. Easily transmitted. All of that is bad enough with this bugger. But now fo rht ebad news. It’s resistant to commonly used disinfectants and antiseptics. OMG! Now what do we do?!

Data in this entry was found in an article entitled Clostridium Difficile Infections in Nursing Homes from Vol. 7, Suppl. 1—March 18, 2010 of the Pennsylvania Patient Safety Advisory.

1 Comment

  1. What if the hospitals administration invested in intense education of the clinical care givers (nurses, CNA’s, phleobotomists, FNS, and etc.) and Environmental Services? Then follow that up with standards and insentivise goal attainment. Increase EVS FTEs for areas that have the highest risk for C-dif and other MDRO transmission.

    If you could reduce CDIs by only three to five per year the investment is easily paid for, not to mention the PR benefits!

    Spoiler Alert: Its been done before.

    Greg

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