C. diff goes hyperviral: It’s not just for hospitals anymore

Posted on behalf of Stewart Bell, PLLC on Mar 19, 2012 in Nursing Home Injury or Death

A new study has delivered some startling news to inpatient and outpatient care facilities: The deadly bacterial infection Clostridium difficile has extended its reach beyond hospitals. More clinic and nursing home patients are affected than ever before, and they are affected by a particularly resistant, hypervirulent strain of the bacteria. Fortunately, researchers and one West Virginia physician have some ideas about how to reverse the trend.

The Centers for Disease Control and Prevention released the study earlier this month. The researchers looked at C. diff infection data from a number of national sources and found that both the infection rate and the mortality rate have reached historic highs. What's more, the study undercuts the common belief in the medical community that infections are primarily a problem for hospitals. Hospitals accounted for just 25 percent of new infections, while nursing homes and outpatient facilities accounted for the remaining 75 percent.

Still, of all infections, 94 percent were associated with health care services. As a CDC epidemiologist put it, the results show that C. diff is a patient safety issue "everywhere medical care is given."

The infection, characterized by diarrhea, may not start in the hospital, but it likely ends up there. Nursing home residents are often transferred to hospitals for care, and outpatients who present with acute symptoms are often admitted for care. As a result, hospitals are more skilled at containing the infection -- C. diff spreads easily and rapidly, and the bacteria is getting harder to kill.

The family doctor and primary care clinic play an important role in the battle to limit infections, according to the CDC and a professor from the West Virginia University School of Medicine, though. 

The CDC reports that patients do not need half of the antibiotics prescribed for them. As a West Virginia University School of Medicine professor explains, the antibiotics are actually killing the good bacteria that fend off things like C. diff; an over-medicated patient is more susceptible, not less.

C. diff is easily transmitted from contaminated surface to person, then from person to person. Patients with C. diff are often isolated from others to reduce the chances of transmission, and visitors are fully gowned and gloved. Every surface must be disinfected with a mixture of chemicals more powerful than bleach alone.

On humans, the C. diff spores can survive even vigorous hand washing, and that means that the people who are exposed to the bacteria most often need to take additional measures. What makes that hard is that those people are doctors and nurses in nursing homes and outpatient clinics.

The WVU professor has a simple solution. He suggests that primary care physicians and nurses wear gloves during every patient interaction. It is a simple step that would decrease the risk of transmitting C. diff significantly, he says, but a step that would undermine a doctor's or nurse's bedside manner, his or her relationship with the patient.

As the professor explains it, it can be hard not to shake hands with a patient without gloves on. It's the way doctor and patient have always greeted one another. But when a dangerous infection is involved, both parties may have to change their expectations.

Preventing the Spread of C. Diff

Health professionals say that the increase is related to the medical community's tendency to over-prescribe antibiotics. According to the Centers for Disease Control and Prevention, almost half of antibiotics prescriptions are unnecessary and may do more harm than good. It's not that they just don't work anymore; the overuse of prescriptions actually weakens a patient's resistance to infection.

Antibiotics kill bacteria that cause infection. But, again according to the CDC, while antibiotics are killing some bacteria, others are getting stronger and more resistant to antibiotics. When an antibiotic is actually needed, the medication won't work. The illness will hold on longer, doctor visits or hospital stays will increase, and costs will continue to mount. Medications that are a step up from antibiotics are much more expensive and tend to be more toxic.

When it comes to C. diff, treatment options are limited. Because the majority of C. diff patients already have compromised immune systems -- because they are old or suffer from another serious illness -- the infection can prove fatal.

Health experts recommend that primary care physicians simply cut back on the antibiotic prescriptions, especially for older adults. Of the 14,000 deaths from C. diff every year, more than 90 percent are of people age 65 and older. Doctors should explore other treatment options before resorting to antibiotics. Patients, particularly parents of very young children, may argue the point, but the CDC and other organizations believe that argument can be a teachable moment.

There are ways to prevent the spread of C. diff, and there are ways to prevent the bacteria becoming even more resistant to treatment. The authors of the study urge the medical community to take every measure necessary to stop C. diff infections in their tracks.

Source: AMedNews.com, "C. diff causes concern in primary care, other outpatient settings," Christine S. Moyer, March 19, 2012.

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