C. diff: Gut-Wrenching Bacteria Common and Deadly

KANSAS CITY, Mo. — Think of it as the worst kind of guest. One that will not go away. It sits and sits on a faucet, a phone or remote control. Clostridium difficile or C. diff is a type of bacteria passed in feces to the hands and then to surfaces. C. diff produces spores that won’t go away.

“Oh, it can live for years actually. The spores are very, very tolerant. They’re tolerant of heat and dryness,” says Dr. Becky Horvat, a microbiologist at the University of Kansas Hospital.

When someone touches those microcropic spores on surfaces, the hands pass them, usually at mealtime, into our mouths.  What happens next can be awful. It’s estimated that C. diff will sicken a half million Americans this year, and kill between 14,000 and 30,000 of them.

“I just thought I was dying.  I was just so weak and I had so much pain and the cramping, the constant diarrhea, the throwing up,” says Jessie Ethetton.

Her father, Greg Cracraft, says, “It’s tough when she looked at me in the eye and said ‘Dad, am I gonna die?’  It’s tough, you know.”

Jessie did almost die of C. diff.  She spent more than a month in a hospital with her colon swollen to five times its normal size.

“She was very near to having an emergency surgery to take her colon out,” says Dr. Marc Taormina of Midwest Gastroenterololgy.

Nearly a hundred pounds of fluid built up in her body. Her father says she was becoming more short of breath and more swollen.

Jessie, a hair stylist, has no idea where she got C. diff. She does know what made her healthy, 22-year-old body susceptible. She had been taking an antibiotic for a bladder infection. C. diff is an opportunist of the worst kind. It often moves in when antibiotic use wipes out not only the bad bacteria in the body but also the good kind in the colon.

“And allows this bacteria to overgrow, and it creates a toxin which injures the lining of the colon and results in this severe diarrhea, systemic inflammation,” says Dr. Taormina.

Antibiotic use is one factor in C. diff most commonly striking and killing older adults in nursing homes or hospitals. But the head of the Committee to Reduce Infection Deaths or RID says make no mistake, antibiotic use isn’t the cause of C. diff infections there. Betsy McCaughey says it’s inadequate cleaning of surfaces.

“The number one problem is hospitals need to clean the high-touch surfaces right around the patient bed with bleach. Bleach is really the only thing that kills these C. diff spores.”

At the University of Kansas Hospital, they use bleach on those surfaces. It’s one of many steps caregivers say they’re taking to avoid the spread. Workers wear gloves and gowns when they go into the rooms of patients with suspected or confirmed C. diff. Infection control staff emphasize handwashing because with C. diff, gel won’t do. Only vigorous washing with soap and water can get the bacteria off hands.

“It’s physically removing those spores if they’re present on health care workers’ hands and getting them down the drain,” says Marc Molitor, infection control nurse.

But McCaughey with RID says what about the patient’s hands? They need cleaning, too.

“There’s little effort in most hospitals to insure that patients’ hands are clean, particularly before meals,” says McCaughey.

At the University of Kansas Hospital, they’re testing a high-tech weapon against C. diff. A machine emits UV C light. Molitor says when the light hits the spores, it doesn’t kill them, but it does render them harmless.

“What it does, it deactivates, it affects the RNA and the DNA of the microorganisms that may be present in the room,” says Molitor.

The machine which costs more than $100,000 dollars is used after the standard cleaning of the room when a patient is discharged.

McCaughey says nursing homes and hospitals should also clean surfaces with bleach while patients are in rooms.

“They’re not routinely cleaning these surfaces every day, but the surfaces become recontaminated every day,” says McCaughey.

Molitor says patients and loved ones should speak up if workers aren’t doing routine cleaning or taking other precautions.

“We ask our nurses and other staff members to graciously accept any reminders and thank people,” he says.

Jessie Ethetton knows that a quarter of people who survive C. diff will get sick with it again.

“Just my anxiety level is a lot higher now that I’ve been sick and in the hospital and almost died,” says Jessie.

Beginning January 1, Medicare and Medicaid will require hospitals to publicly report their number of C. diff infections. That, along with new penalties for re-admissions, may lead hospitals to do more to prevent the spread.

For more information on preventing C. diff, visit hospitalinfection.org./preventing_cdiff.shtml

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