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How to get rid of C. diff?

According to this Medscape article, trying to get rid of Clostridium difficile spores by using traditional hand sanitizers won’t cut it.

C. difficile spores are everywhere, including tables, curtains, lab coats, scrubs, plants and cut flowers, computer keyboards, bedpans, furniture, toilet seats, linens, telephones, stethoscopes, jewelry, diaper pails, fingernails and physician’s neck ties.

The spores themselves aren’t harmful, but when they are ingested, they can transform and cause colitis. C. difficile spores are difficult to eradicate because they secrete a sticky substance allowing them to adhere to surfaces which, in turn, makes them difficult to remove. Think of little beads with a honey coating.

In the Medscape article none of the cleansing products – even the soaps – removed more than 90% of C. difficile spores.

According to this study, C. difficile can be cultured from the stool of 3% of healthy adults and 80% of healthy infants.
This MSNBC article shows that C. difficile is present in 40% of grocery meats.
According to this commentary, more than a third of patients in a North Carolina study had community-acquired C. difficile infections (i.e. not the hospital’s fault) and more than half of patients with C. difficile recently used antibiotics.
And … one of the quality measures forced upon us by CMS and Hospital Compare requires us to use antibiotics on ALL known or suspected cases of pneumonia within 6 hours of the patient’s arrival. These “quality measures” significantly increase antibiotic use without any improvement in mortality or hospital length of stay. At the same time, they increase the likelihood of C. difficile infections.

C. difficile is present in up to 40% of the meat we eat.
C. difficile is commonly present in the stool of healthy infants and adults.
We can’t completely get rid of C. difficile spores no matter how much we wash.
And … for the sake of “quality care,” the government forces us to give many patients unnecessary antibiotics that actually increase the chances that a C. difficile infection will occur.
But if C. difficile infections occur in a hospitalized patient, the government won’t pay to treat them because the infections are “never events” and should “never” happen.

Go figure.

6 Responses to “How to get rid of C. diff?”

  1. Nurse K says:

    If C.diff is a never event, it only follows that we should rip out the colons of 80% of infants and 4% of adults before they are admitted to the hospital. That’s really going to ruin patient flow, but it’s the right thing to do.

  2. Nurse K says:

    Hm, it said 3%, but, I guess, 4% is okay because if you’re not ripping out extra colons, you’re probably missing some patients who have colons with C.Diff.

  3. toni says:

    Question. Is there any way to lesson the chance of getting c-diff when on antibiotics?

    Our hospital doesn’t change the privacy curtain in the room between patients. It’s gross. Poopy hands touch that curtain. I hate touching them. Just a rant. The CNA’s don’t clean the vitals machine betweeen patients either. Another rant. Alot of nurses don’t clean their stethoscope between patients. Rant Rant Rant.

  4. Chris says:

    Are the majority of c diff colitis cases acquired in hospitals from endogenous or exogenous bugs? Evidence points to them being largely exogenous in pathogenic cases – thus the rationale for contact precautions and “never event” stuff, etc.

    I think that we need to look at evidence-based studies for the effectiveness of strategies that reduce never events and whether these strategies simply reduce events or also reduce more meaningful measures like time in hospital, mortality, etc.

  5. I’m having a hard time finding a geriatric patient that doesn’t have hx c diff…any little squirt and we slap them into isolation with our hazmat outfits on. Glad you posted on this…levaquin 750 mg IV as a CAP protocol and hx c c diff pretty much guarantees an episode. Absolute overkill.

  6. marie says:

    I know I’m preaching to the choir on this one, but the whole concept of “never events” seem to prove that a little knowledge possessed by a large, powerful group of laymen is dangerous.

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