Objectives:
-Describe C-Diff
-Discuss the transmission of CDiff
-Describe the actions of healthcare facilities in response
Outline:
• We have all heard of Clostridium Difficile or “C-Diff” as we commonly hear it being used in our healthcare facilities. What exactly is C-Diff?
The definition from the CDC says it is a spore forming, gram positive anaerobic
(meaning it can grow without oxygen) bacteria that produces two exotoxins (a potent toxin formed and excreted by the bacterial cell, and free in the surrounding cells): toxin A and toxin B. It is a common cause of antibiotic associated diarrhea (AAD) and it is responsible for up to 25 % of all antibiotic-associated diarrhea. In other words, it is a bacteria that lives in the large colon and causes anything from terrible diarrhea to life threatening inflammation of the colon.
• There are half a million cases of C. difficile in the US each year, up from 150, 000 cases in 2001. The infection may be responsible for as many as 30,000 US deaths each year. The number may be higher as it is not yet a reportable disease.
• Hands and surfaces contaminated with feces spread the disease. Recent outbreaks of an epidemic strain indicate increased virulence and antibiotic resistance. More people are affected by the disease, and more are showing severe symptoms. Like MRSA, C. difficile is now being seen in what used to be considered "low risk" populations such as healthy people in the community and pregnant women.
• The mortality rates have risen from 6 deaths per million in 1999 to 24 deaths per million in 2004. Long term care facilities are particularly vulnerable and it is important for the general public to know that infections can occur from contact with contaminated environmental surfaces.
• C. difficile infection represents one of the most common hospital (nosocomial) infections around the world. In the United States alone, it causes approximately three million cases of diarrhea and colitis per year. This bacterium is primarily acquired in hospitals and chronic care facilities following antibiotic therapy covering a wide variety of bacteria (broad-spectrum). This is the most frequent cause of out-breaks. of diarrhea in hospitalized patients.
• An important characteristic of C. difficile-associated diarrhea and colitis is its high prevalence among hospitalized patients. Thus, C. difficile contributes significantly to hospital length of stay, and may be associated in some elderly adults with chronic diarrhea, and occasionally other serious or potentially life-threatening consequences. One study demonstrated that 20% of patients admitted to a hospital for various reasons were either positive for C. difficile on admission or acquired the microorganism during hospitalization.
• Interestingly, only one-third of these patients developed diarrhea while the remainder were asymptomatic carriers serving as a reservoir of C. difficile infection.
