In every profession we put the knowledge we have learned to use each day. While many people work on the frontlines of healthcare, where resilient bacteria live and thrive, most of us do not. We work in manufacturing facilities or on construction sites, where worries about the dangers of cuts, musculoskeletal injuries and falls are top of mine and very few people are concerned about the dangers of bacteria.
Clostridium difficile (C Diff) is a resilient bacteria most commonly found in healthcare settings, but it is gaining momentum in communities and work environments and can be fatal. C. Diff is gram-positive and anaerobic; it is a spore that is able to live without oxygen. It is of the genus Clostridia, which is a common bacterium of the human intestine in 2 to 5 percent of the population. Previously, C Diff only became a serious gastrointestinal infection when individuals were exposed to antibiotic therapy, experienced long-term hospitalization or had an extended stay in a long-term care facility.
However, the risk of acquiring a C Diff infection (CDI) is increasing since it is highly infectious and can live for as long as 3 months on hard surfaces. This means that someone who has acquired C Diff and who does not practice good hand hygiene can transfer it to another person via a door handle, shopping cart or public restroom. As a result, C Diff is spreading throughout homes and workplaces.
There are significantly higher risk factors of acquiring C Diff for individuals who have weakened immune systems due to cancer, other medical conditions that lower their ability to fight infections, people who have been on antibiotic therapy and the elderly population. Antibiotics cause a disruption in the normal intestinal flora which leads to an over growth of C difficile bacteria in the colon. The leading antibiotics known to disrupt the normal intestinal flora are Ampicillin, Amoxicillin, Cephalosporin, and Clindamycin, which are broad-spectrum antibiotics. Proton pump inhibitors have also been shown to be associated with an increased risk for CDI.
What are the symptoms of CDI? C diff strains produce several toxins; the most popular are enterotoxin – Clostridium difficile toxin A, and cytotoxin – Clostridium difficile toxin B. Both strains are responsible for causing symptoms such as diarrhea, abdominal pain, fever and fatigue, and can advance to a severe inflammation of the colon known as pseudomembranous colitis, which can also lead to further complications of toxic megacolon.
CDI either can be transmitted directly or indirectly: hospital acquired (nosocomial) or community acquired; Ingesting C Diff spores transmitted by others’ hands; or altered normal intestinal flora by antibiotic therapy allowing proliferation of C Diff in the colon. Clostridium difficile spores surviving on surfaces, devices or material easily can be transferred to workers through their hands. Examples of surface, devices and materials contaminated with C Diff spores most commonly include public restrooms, portable restrooms; sinks, water faucets, diaper changing tables, commodes, bath tubs, showers, hand rails, bed rails, counter tops, handles, clothing, door knobs and light switches.
Treating CDI is becoming more challenging to physicians, frustrating to patients and costly to the health care industry. To date, there are three antibiotics effective at treating CDI: Metronidazole is prescribed to treat mild to moderate symptoms and is cost effective. Vancomycin is prescribed for moderate to severe symptoms and is prescribed to patients with unsuccessful results from the Metronidazole, or if the patient is allergic, pregnant, breastfeeding or younger than 10 years of age. The most recent antibiotic, Dificid (fidaxomicin) is the first medication approved by FDA to treat CDAD in 25 years with superiority in sustained clinical response.
In November 2012, the Centers for Disease Control and Prevention (CDC) shared a public announcement regarding antibiotic use, stating that colds and many ear and sinus infections are caused by viruses, not bacteria. Taking antibiotics to treat a virus can make those drugs less effective when people really need them. Limiting the usage of antibiotics also will help limit new cases of CDI.
C Diff spores are able to live outside of the body for a very long period of time and are resistant to most routine cleaning agents. It has also been proven that alcohol-based hand sanitizers remain ineffective in eradicating C Diff spores.
In 2009, a commercial Clorox product (Commercial Solutions Ultra Clorox Germicidal Bleach) was named the first and only product to obtain Federal EPA registration for killing Clostridium difficile spores on hard, non-porous surfaces when used as directed. However, that product should not be confused with Clorox wipes, which are not effective in killing C Diff spores. As of 2013, there are additional EPA-registered disinfectants and sporicides (Steriplex SD, Excelyte, etc.) that can be used to clean hard surfaces for C Diff and other harmful germs. The CDC also recommends a 1:10 dilution of bleach and water (one cup bleach to nine cups water; mixed fresh daily) with solution remaining on hard surfaces for 10 minutes for cleaning.
Hand hygiene remains the No. 1 prevention for transmission of germs. The most important step is to wash your hands when exiting a restroom, before and after eating, before and after diaper changes, before and after operating heavy equipment, before and after using shopping carts and before and after visiting a patient’s room. Use water and soap and wash for more than 20 seconds - the minimum length of time noted for efficient hand washing technique. Once finished washing, turn off the water faucets with a dry towel and dry hands with a clean towel.
Prevention through education about CDI has proven effective and beneficial to environmental housekeeping departments, housekeeping organizations, professionals in the work place, health care professionals, administration, patients and their families.
Abut the author: Nancy C Caralla is the executive director of the C Diff Foundation, which is engaging in education efforts and advocating through group presentations, literature, publications, health conferences and health fairs, webinars and through social networking avenues.