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    Wednesday, January 18, 2006

    Absence of Malice: C. diff colitis has captured our newspaper's imagination. Beacon Journal | 01/17/2006 | Bacteria stalking patients:

    Wendell Forrest was hospitalized for pneumonia in May and never recovered.

    Before the 75-year-old Coventry Township resident died this month, he suffered from a number of infections, including four caused by the bacterium Clostridium difficile, or C. diff.

    Although they are not listed on his death certificate, his wife, Reta, 69, believes the infections, and especially the C. diff, played a crucial role in his death.

    ....Forrest became infected with C. diff shortly after he went into an Akron-area hospital for pneumonia. To treat the pneumonia, he was given antibiotics and put on a ventilator.

    He was given more antibiotics to treat his C. diff infection, his wife said, but, after he was moved to another unit in the hospital, he suffered another, more severe bout of the infection.

    ``You just have diarrhea till you're so weak,'' Reta Forrest said. ``... Each (bout) was worse than the last.''

    Wendell Forrest was in the hospital for a month and a half. Then, over the next three and a half months, he stayed in a rehabilitation facility and nursing home. He was slowly recovering and walking again, his wife said, when two more bouts with C. diff landed him back in the hospital in late October.

    ``I think after the last C. diff (infection), that really was the beginning of the end,'' she said.

    .....But Reta Forrest said during her husband's stays in medical facilities while he had C. diff, he was in rooms with other patients, and staff members and visitors did not wear protective coverings.

    ``I did see nurses that didn't wear gloves,'' she said. ``Mostly they did -- I would say... 97 percent (of the time). But there were times when I would see them put food into the feeding tube, and they were not wearing gloves.

    ``Where did all this infection come from?''

    It came from his body. C. diff is not a bacteria that invades from the outside. It's one that conquers from the inside. Small populations of C. diff live in everyone's colon. When people take antibiotics (and maybe proton pump inhibitors), it changes the environment of the colon just enough that the C. diff population increases. The result is, that it takes over. It's a demographic shift that results in bodily havoc. Much the same as if there was a demographic shift in a nation that resulted in a violence-oriented group suddenly becoming the majority.

    This concept of an infection from within is difficult for many people to grasp. Articles like this one, which makes it seem as if C. diff infections are the fault of hospitals and nursing homes are no help.

    While it's true that the bacteria produce spores which can in theory be passed on
    from one person to the next, it isn't especially contagious. It isn't, for example, as contagious as viral gastroenteritis.
    But, because people in the hospital tend to be of frail health (not to mention on antibiotics), they are especially susceptible to it.

    The number of cases seems to be increasing, and more of them seem to be resistant to the antibiotics we use to subjugate the C. diff population. The emphasis, however, is on the "seems." C. diff infections - at least in Ohio - weren't considered reportable infections. They were just considered complications of antibiotic therapy. Until yesterday. As of yesterday the infection became reportable to the health department. The reason it became reportable is to get a handle on just how widespread it is, and to see if it really is as much of a growing problem as it seems.

    Reporting of the infection just started yesterday, but already this morning the newspaper has a story about it - 22 cases in the county!. Wow. I have to confess. That's a lot lower than I would have guessed.
    And as the health officials keep trying to tell the newspaper , this is not a "blame game." It's an effort to understand the epidemiology of a disease.

    They aren't getting the message:

    Jennie Speer, 45, of Copley Township, is a nurse who contracted C. diff twice and has not worked for more than a year because of related health issues.

    She said the reporting is a good first step but is interested to see what comes as a result of the effort.

    posted by Sydney on 1/18/2006 08:27:00 AM 3 comments


    I have been interested in C-diff for a while now. I agree that the blame game is not the answer. I was hospitalized last year with a bad case of Salmonella and I was so happy when the culture came back with that instead of C-diff! I felt like I had dodged a bullet. I am especially vigilent about following the contact procautions when dealing with infections. I don't want to contaminate myself, my family or other patients. These infections are mutating and it's all we can do to stay ahead..

    By Blogger Nurse Practitioners Save Lives, at 11:18 AM  

    One important point about c. diff and hand washing - you need to use actual soap and water, NOT the new alcohol based preparations. The alcohol hand rubs are not effective in eradicating c. diff.

    A couple of years ago I managed a sub-acute ward of patients, most on chronic antimicrobial tx and we had repeated c. diff outbreaks. Many inservices were held to educate staff re: NOT using the recently installed alcohol hand rubs when caring for c. diff patients. Terminal cleaning of the rooms and equipment was important as well.

    By Anonymous CardioNP, at 3:38 PM  

    She said the reporting is a good first step but is interested to see what comes as a result of the effort.

    Come on, everyone knows what will come of it. Lawsuits.

    By Anonymous Anonymous, at 7:18 PM  

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