Clostridium Difficile - Was: Wounded soldier contracts MRSA

Discussion in 'Professionally Qualified, RAMC and QARANC' started by Goatman, Feb 5, 2007.

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  1. Goatman

    Goatman LE Book Reviewer

    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.

    Some common dog practical measures on the site , culled from people posting their tips in the forum, may be worth reprinting here, FWIW:

    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.

    Le Chevre
  2. All dead useful

    Thanks for posting this

    Mind you, as a nurse working many busy nights, it's not the lack of knowledge or motivation that means corners get cut - but sheer intensity of work - but it's always useful to have the info in b&w
  3. Goatman

    Goatman LE Book Reviewer

    No probs Lawn, and as I say, no disrespect to all the hard grafting folk who are doing their damnedest out there to keep this bloody thing at bay.

    It may seem daft to teach people HOW to wash their hands effectively but.....

    Some good links to US info concerning c.difficile on the support group website too.

    ( Anyone who went to same school as Michael Palin can't be all bad ;-) )

    Lee Shaver
  4. it's not daft sadly
    but then if you are working with 20 patients on a shift, most of whom require some form of contact and you need to keep yr hands clean as well as answer phones/questions etc - well, let's just say it gets complicated. Me, if I'm stood still I disinfect my hands with gel as a kind of nervous tic ... but then I've caught OCD to go with my MRSA and CDiff :)
  5. Goatman

    Goatman LE Book Reviewer

    Blimey....comes to something when a nerdy microbiologist's arcane bug makes the front page of the Daily Mail.....

    Le Chevre
  6. Without wishing to be disrespectful to anyone on this site whose family have suffered C. difficile, MRSA or any other hospital acquired infection some of what has been quoted is utter fecking nonsense. For example:-

    C.difficile is spread "through the air if another infected patient uses a commode nearby". No, C. difficile is NOT an airborne infection.

    "Infection rates are thought to be 10-20% for the first two weeks and over 50% after a month". This is meaningless drivel, it has no value what so ever.

    "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". A 90 degree wash will NOT kill bacterial spores, you need 134 degrees at 2.25 bar for 3 mins to achieve a sporicidal effect.

    "there is a period of incubation usually, but not always, after the original antibiotic has finished". The symptoms frequently start before the original antibiotics are finished, which is why stopping the antibiotics (if it is safe to do so) can sometimes be all that is needed for the diarrhoea to cease.

    "but you could push for a stool test if your relative/friend has any of the incubation symptoms". There are NO incubation symptoms.

    "The cost of MRSA to the NHS is put at £1billion a year". More bollocks from the Daily Wail. Whilst it is true hospital acquired infections cost £1 billion per year it is not true that MRSA costs £1 billion per year.

    Lord Hunt said "As a result we are now starting to see significant reductions in rates of MRSA infections". I wish this was true, especially in the Trust where I work. The truth is that with one year to go to reach the 50% MRSA reduction that John Ried set as a target the overall reduction is only about 5% over the past 3 years. Of course Lord Hunt is quoting the actual number of cases, if you look at the rate (per 10, 000 bed days per trust) it is unchanged compared with 3 years ago (about 0.16 cases per 10,000 bed days).

    John Reid said in 2004 "I expect MRSA bloodstream infection rates to be halved by 2008". I remember this quote like it was yesterday as everyone I know in microbiology and infection control thought it would not be achieved and thought Reid had set us up to fail. He chose not to consult with any experts before setting this target.

    Also worth remembering that despite all the hype there has been NO increase in the prevalence of hospital acquired infection over the last 25 years. In the 1980s it was 9-10%, in the 1990s it was also 9-10%, in 2006 it was 7.6%.

    If anyone wants to know about specific infections for fecks sake don't use these self help sites because if what was quoted above is really the "best" they can offer then they are misleading. Try the Health Protection Agency (UK) or the Centers for Disease Control (USA).
  7. Goatman

    Goatman LE Book Reviewer

    Thanks for that J-B - always good to get the professional viewpoint.
    I appreciate this is every day stuff for you and I have no doubt you have forgotten more about microbiology than I'll ever know.

    Instead of slagging off the views expressed in the Support Group, which I have quoted as seen, maybe you could get in touch with the Web-manager and point out the error of their ways? I'm sure they would welcome some input.

    The site is

    From my (dumb grunt) perspective what that site is about is trying to help people with elderly relatives in hospital, who are looking for something other than being fobbed off by over-stretched ( and occasionally I have to say, downright arrogant) NHS staff with a lot of half-truths about C.Diff.

    As you say, many of the U.S sites give chapter and verse: always worth Googling on treatment and prevention.

    At the very least what the Daily Wail article may have done is raise awareness of the problem - a 69 per cent increase in a year ffs - and if that means that a single patient goes home WITHOUT contracting C.Diff. well I guess that'll be a plus.

    A general question to Med practitioners reading this thread:

    What's the awareness campaign on C.Diff like in the hospital YOU work at ?

    Le Chevre
  8. If any patient or relative has been fobbed off over C. difficile then clearly that is wrong, however half-truths from whatever source (including support groups) should be challenged. My point is that whoever wrote the "advice" quoted needs to realise that it is misleading and I will do as you have sensibly suggested and email them.

    Yes rates of MRSA and C. difficile are increasing and patients and relatives have a right to be worried and concerned. What also concerns me is the number of lay people who pass themselves off as "experts". Let me give an example. A couple of years ago a company in Coventry called the Training Foundation launched a electronic web based learning package for NHS staff to use which was called "MRSA - You can make a difference". The marketing was at best pushy and at worst possibly illegal. They had got together with an organisation called MRSA Support and were threatening to name and shame any trust that had not brought the product. My Strategic Health Authority, like many other NHS organisations, bought a one year user license at a cost of £125,000.

    Various people within infection control nationally were muttering that this package was not very good and I was tasked with looking at it in detail. What I saw really concerned me. One of the tests in the package was a scenario in which a post op hip replacement patient has a temperature and you were asked what to do next. The "right" answer according to this training package was to swab the patient's nose and groin to look for MRSA. Well you could do that but sadly it won't lead you to understand if the patient has an infection or what the cause might be. In such a patient if an infection was suspected then the respiratory tract, urinary tract and wound would be more likely to be affected. The presence of MRSA in the nose or groin is not going to give a patient a temperature as its almost certainly only colonisation rather than infection. Thus the learning package was advocating dangerous practice. I challenged the Training Foundation as to the background of the authors and it turned out, as I suspected that they were not really qualified to advise or train others in this area.

    “What's the awareness campaign on C.Diff like in the hospital YOU work at ?”

    The labs inform the infection control team of every new case of c. diff
    Each case is seen by an infection control nurse and if necessary isolation recommended (not every “case” actually has active symptoms)
    First line treatment is commenced and if possible the original antibiotics stopped
    An advice sheet is given to the nursing staff and a leaflet is available for patients and relatives
    The patient remains in isolation until symptom free for 48 hours
    The room is cleaned daily and on discharge with 1000ppm sodium hypochlorite using separate cleaning equipment
    Staff routinely wear gloves and aprons for known or suspected cases.
    The infection control team routinely keep tabs on the numbers of new cases per ward per week in case of an outbreak.
    Like MRSA rates per month of C. diff are reported back to wards and managers
    Antibiotic protocols are used to use only those drugs which lessen the risk of inducing C. difficile disease.
    The trust’s c. diff policy is current and reviewed every 24 months.
    The trust’s new e-learning package for infection control has a section specific to C. diff.
    We are (as per DoH recommendations) currently in discussion with our local PCT to agree C. diff reduction targets for the next 12 months.

    I could go on but that’s probably enough.
  9. BBC reported that UK infection rates are 44 times higher than those in Holland.

    The solution would seem to be simple. Unless you are absolutely knackered, impaled on something or bleeding to death do the following:-

    1 Nip home and grab your European Health Insurance Card
    2 Hobble to the nearest airport
    3 Jump on the next flight to Amsterdam
    4 On arrival, take a taxi to the nearest hospital
    5 Obtain 1st class treatment and live to tell the tale
  10. AM do you have a link for that BBC report? I've looked at the site and can't see it.
  11. It was on the TV news about a week ago when the latest stats. were released by the Office for National Statistics. A bar chart was shown. IIRC it showed the percentage of blood borne infections that were caused by either MRSA or C.diff.

    The chart showed Holland with the lowest levels at 1% and the UK with the highest levels in Europe at 44%.
  12. Thanks AM, I think I know what the BBC are refering to. This is the proportion of Staphylococcus aureus which is methicillin resistant (i.e. MRSA) identified from blood cultures in various different countries. Holland along with Norway, Sweden and Finland have a very low incidence, <1%. In the UK we are indeed at about 44% and along with Ireland, Spain and Greece are at the bad end of the European picture. Globally it gets more interesting, the US and Canada have very different rates which is strange as they have very similar health care systems, with the USA at 38% but Canada only 2%. In the Far East its even worse especially Japan where 80% of Staph aureus from hospital blood cultures is MRSA.
  13. Goatman

    Goatman LE Book Reviewer

    I've never been in either a Cloggie or Scandiwegian hospital ( touch wood)....are they COLDER than UK hospitals as well as cleaner?

    Why is it every NHS hospital I've ever been in seems to be kept at optimum temperature for growing orchids ( and presumably bugs ?)

    Lee Shaver
  14. Because they're full of pensioners who wear their overcoats to the shops during the summer, at noon, during a heatwave.
  15. Goatman

    Goatman LE Book Reviewer

    ...and medical staff who've seen ER and Scrubs and think floating around in sterile V neck Tshirts in December is cool.....

    Le Chevre

    PS you fit for squash yet ?