The link in the earlier post is to a support Group set up by a woman whose mother died of infection brought on by C.difficile.Accidental_discharge said:Clostridium Difficile causes much more than just the trots, it may lead to multi organ failure then death, ETOH gels are inefective against C-Diff, as it does not kill the spores that remain on the hands after use with said gels. The spores need to be physically removed, soap and running water.
Methycillin Resistent Staph Aureus may appear colonized in asymptomatic individuals and passed on unknowingly, it may even be found colonized in family pets.
All hospitals, regardless of appearance are breeding grounds for all sorts of hideous bio killers.
Some common dog practical measures on the site , culled from people posting their tips in the forum, may be worth reprinting here, FWIW:
These tips are a selection of the âbest ofâ from this siteâs discussion forums. The tips have been written by C-Diff sufferers who have tried them and found them to work. Most have been written by people who do not have a medical background and they are not a substitute for seeking proper medical advice from a qualified medical practitioner. We cannot accept responsibility for the advice given here. If you are at all concerned, please go and see your doctor.
Infection Control Measures
Hand Washing is the single most important method of controlling infection by C-Diff. C-Diff spores are highly resistant to most cleaning materials, therefore the physical action of hand washing is important. If you are visiting someone in hospital, the alcohol gel on wards will not help: it will simply rub the spores around your hands.
Hands should be washed: -
After visiting the toilet
Before helping someone with their food
Before handling, preparing, serving or eating food
When the hands are visibly soiled.
How to wash your hands
Studies show that handwashing techniques are often poor and the most commonly neglected areas are the tips of the fingers, palm of the hand, and the thumb.
It is important that hand washing is carried out correctly to prevent the spread of infection. Washing hands with soap and warm water will remove the majority of germs, preventing their spread to other people.
Wet your hands with warm, running water and apply liquid or clean bar soap. Lather well.
Rub your hands vigorously together for at least 15 seconds.
Scrub all surfaces, including the backs of your hands, wrists, between your fingers and under your fingernails.
Dry your hands with a clean or disposable towel
Cleaning Around the Home
Clostridium Difficile Spores are highly resistant to cleaning agents and will live for between 70-90 days outside the body and are only killed by cleaning agents containing Chlorine Bleach. Hard surfaces that will not be damaged by these cleaners such as toilets, (donât forget the flush and door handles) baths and work surfaces should be cleaned with proprietary cleaning agents containing bleach. Obviously please use some common sense and donât use cleaning products containing bleach on unsuitable surfaces such as carpets or soft furnishings.
There is some evidence that at low temperature washes (30 Degrees) Clostridium Difficile spores may be washed out of contaminated clothes and remain within the washing machine pipe work and sump. The spores could then be washed back onto clean clothes. Therefore, it is a good idea to use a washing powder containing chlorine bleach i.e. NOT a âcolourâ or non-bio product, and to use powder rather than liquid. This is because liquid detergents contain bleaching agents which may or may not contain chlorine bleach, whereas powders contain actual chlorine bleach.
It is also a good idea to run a 90 degree wash once a month with the machine empty and a full load of detergent to completely clean out your washing machine. This ensures that all potential c-diff spores are killed and also cleans out any old soap residue from your machine making for more efficient washes.
C-Diff Sufferer Care
While pro-biotics are highly beneficial in re-establishing gut flora, two important details must be considered:
It is of no use to take pro-biotics while youâre being treated with antibiotics for Clostridium Difficile. Any âfriendly bacteriaâ will be killed off immediately by the antibiotics treating the C-Diff and will not get a chance to establish themselves. Wait until you have completed your course of antibiotics.
There is considerable debate in medical circles about how much bacteria is actually âliveâ in commercial pro-biotic products. There is concern that not many live bacteria get through the concentrated acid in the stomach. There is also debate about which strain of good bacteria is most beneficial. Pro-biotics are therefore a can of worms with large commercial interests at stake. Very few products have been medically tested and approved (with the exception of VSL3 from Sigma Tau Pharmaceuticals which at this point (Jan 2007) is not distributed in the UK. However this is going to change in the next few months
Therefore the best current advice is to make your own live yoghurt using an electric yoghurt maker with full cream UHT milk and a âliveâ starter such as âTotalâ yoghurt, or another brand of live yoghurt, and leave it to ferment for a full 24 hours. This gives a finished yoghurt that tastes great, has a bacterial yield in the trillions that you know are live, has not been through a long supply chain where the bacteria may have started to die, and the lactose in the milk has been broken down making it easier to digest. It is not a good idea to use the Easy-Yo Yoghurt Maker for pro-biotic yoghurt as it is not heated and therefore unsuitable for a 24-hour fermentation process.
Oats contain beta glucans that are highly beneficial in helping to re-establish the gut flora. If you can manage it try to include some oats in your diet in any form. For active C-Diff, fine ground oats like âReady Brekâ or fine oatmeal made into a simple porridge are easy to digest, but any products containing oats will help.
If you have a relative or friend in hospital with C diff
Here are some facts and figures about C. diff which should help you.
Usually the patient will have been given a broad spectrum antibiotic. This kills off all bacteria, friendly and unfriendly, leaving the patient vulnerable to C. diff spores which are very resilient. The source of the infection can be anything from contaminated equipment (e.g. portable apparatus for measuring blood pressure) which goes from patient to patient, toilet handles and sink taps, cups of tea where the care assistant has previously cleared up another patientâs mess, or even through the air if another infected patient uses a commode nearby. The spores must be ingested. Infection rates are thought to be 10-20% for the first two weeks and over 50% after a month. C. diff 027 is particularly virulent strain.
We all know about the diarrhoea, but there is a period of incubation usually, but not always, after the original antibiotic has finished. Associated with C. diff are low grade fever, overgrowth of white blood cells, and episodes of low blood pressure. The patient feels unwell and will probably experience some abdominal discomfort. The diarrhoea is relentless, very watery, and may have blood and mucus in it. Loperamide (Immodium) is not recommended in the UK, but in parts of the US it is prescribed for C. diff diarrhoea. The thinking is that as long as waste products are still 'going throughâ; this is gentler on the colon and less debilitating for the patient. Blood in the stools is a strong indicator of pseudomembranous colitis. This is a potentially dangerous stage of C. diff where dead tissue forms a sort of plaque on the surface of the colon. When this dead tissue is shed into the stools, a raw surface is left on the colon. This can become infected with other bacteria leading to sepsis. This last causes toxic shock which can lead to organ failure and death.
Diagnosis and Treatment
A stool sample is tested for the presence of C. diff toxins A and B. Colon damage can be assessed during a sigmoid or colonoscopy which can diagnose pseudomembranous colitis. Thickening of the bowel wall is also seen in a CT scan. Usually testing is only carried out when diarrhoea is present, but you could push for a stool test if your relative/friend has any of the incubation symptoms.
Two antibiotics are most commonly used to treat C. diff: Metronidazole and Vancomycin. Metronidazole is the preferred first option. It is cheaper than Vancomycin and does not mutate certain gut bacteria. Metronidazole is very sick making but it is effective against C. diff. Unfortunately C. diff can recur. Again, if you suspect C. diff, don't wait for test results, badger the medics to start treatment with Metronidazole or Vancomycin. C. diff is very fast acting and if you wait for even a few days, irreversible damage may be done. Better safe than sorry.
Now on to the alternative medicine stuff. There is a lot of confusion here, and everyone has their own pet theories. Most of this information has been dissected from clinical trials and research papers in US and Canada and has been proved effective. In the UK probiotics are not prescribed. Probiotics are mostly friendly bacteria which can be obtained as yogurt drinks or tablets. You have probably seen advertisements on the telly for Benecol and Danone drinks. Most supermarkets have 'own label' ones which are very cheap and come in lots of flavours. If your relative/friend likes these then administer them, C.diff or not. They MAY help prevent infection. There are lots of different tablets which contain the same bacteria as the drinks. Multibionta, probiotic vitamins by Seven Seas, has lactobacilli and bifidobacterium, as well as useful vitamin and mineral supplements. It is relatively cheap and most chemists and supermarkets stock it. If your relative is on Metronidazole or Vancomycin it is still worth taking probiotics, but give them halfway through doses, otherwise they get killed off like the rest! See also advice above on homemade yoghurt. Now for the contentious one. You may have heard about Florastor, (Saccharomyces boulardii). In the US this is administered with Metronidazole and Vancomycin. This probiotic is actually a yeast and clinical trials have proved that it is very effective in preventing C.Diff toxin damage. Also, because it is not a bacteria, it is not destroyed by antibiotics. The assumption is that it produces an enzyme which inactivates the toxins. It is completely harmless and can be given any time and MAY play a role in prevention of C.diff infection. A word of warning here. Patients are starved and possibly purged before colonoscopies, flexible sigmoid scopes and operations. CT scans involve a short fasting and prep. Usually a 'nil by mouth' sign is put above the bed, so before giving yogurt drinks check that your loved one is not booked for a scan. Otherwise they are a harmless and nutritious addition to the diet.
Getting Information From Hospital Staff
Don't wait to be told! You have to be very persistent if you want information. Instead of asking open ended questions like 'Tell me about C.diff'. Ask specific ones like these: 'Has he had a C.diff positive stool sample?' âDoes she have pseudomembranous colitis?' If the answer is no or not sure, ask what steps they are taking to find out. Get the idea? Don't ask for permission to give life saving probiotics to your relative. Just do it!!
It goes without saying that a positive C.diff test should result in isolation from other patients. Does this always happen? Not on your life! The main reason is that there are not enough side rooms for the huge number of cases. Also nurses cheerfully drag the same equipment in and out of wards and side rooms. Again, you have to be insistent here. C.diff cases on an open ward are a danger to the other patients. So if your relative or another patient in the bay has C.diff, insist on isolation. If they refuse or procrastinate, say you will complain to the health authority or the newspapers. Take pencil and paper and get names and dates. Look obvious. Believe me, they will act! Also insist on dedicated 'Obs' equipment for infected patients.
If you have a good network of friends and family, try to organise a rota to be with your relative/friend as much as possible. C.diff does not just affect the colon. It does funny things to your head! Patients lose their 'spirit' and become apathetic and resigned. Yet it is very important that morale is maintained because you have to 'fight' C.diff, particularly the pseudomembranous colitis sepsis. Also, people can keep an eye on whether medications are being given properly and the patient is clean and comfortable. It is important to keep up fluid intake, through a drip if necessary, and try to get your relative to eat.
Click here to sign the online petition regarding C.Difficile
No disrespect is intended to nursing staff trying deperately to make wards work. If posting this dit prevents a single case of c.difficile in an elderly patient ( such as either of my parents) it will have been worth it.