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Clostridium difficile: Understanding, Preventing, and Treating

Explore the history, impacts, vulnerabilities, and measures to tackle Clostridium difficile infections. Learn about the challenges, costs, vulnerable populations, protective measures, and what healthcare facilities are doing to combat this bacterium.

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Clostridium difficile: Understanding, Preventing, and Treating

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  1. The difficult bacillusClostridium difficile JANE O’DONNELL ASSISTANT DIRECTOR INFECTION CONTROL

  2. Worth remembering If only causes 10 – 20% of antibiotics associated diarrhoea

  3. Potted history • First described in 1935 • Linked to Pseudomomembranous colitis in 1978 by Bartlett et al • Shown to cause disease in Hamsters • Toxins A & B recognised (1982) • Nosocomial outbreaks observed (1999)

  4. C. Difficile – why it is a problem? • Found in environment and companion animals • Selected in bowel by antibiotic use • Causes mild to severe diarrhoea • Can be difficult to treat • Can spread to other patients • Can cause deaths or make other diseases worse.

  5. Problems with understanding how C. difficile acts • 10% of elderly may carry asymptomatically • 70% of babies carry asymptomatically • In hospital carriage may rise to 15-20%, with no diarrhoea • Colonised patients are less likely to develop diarrhoea when exposed to antibiotics, due to IgG • ?vary immune response to toxin A Kyne L et al NEJM 342 390-97

  6. Costs of HAI some examples • C. difficile diarrhoea - £4,000 (Wilcox et al.) • 20-40% of patients die within 4 weeks of C. difficile positive stool (W. Yorks. Data)

  7. What makes patients vulnerable? • Age • Antibiotics • Proton pump inhibitors • Length of stay (>21 days) • Viral gastroenteritis • Immunocompromised

  8. What measures help? • Don’t treat unnecessarily • Avoid high risk agents • Use low risk agents • Use short courses – review regularly • Don’t use 2 when 1 will do • Avoid multiple courses • Actimel? (St Thomas’ study)

  9. Other measures • Patients with diarrhoea in side-room • Hand washing important • Cleaning of room probably important as organism found in environment round patient • Improve personal hygiene of patients

  10. C. difficile and public health • Increasing number of detections – Why? Increasing awareness Increasing age and vulnerability of patients Increased bed occupancy and ward closures • Increased use of Proton Pump Inhibitors • Effect of D & V due to other causes (Wilcox et al 2007) • Resistant strains e.g. 027

  11. Case Numbers

  12. Case Numbers

  13. What the Trusts are doing • Recording all cases • Reducing patient movement • Visiting and carrying out RCAs • Enhancing training • Improving Antibiotic policies and control measures • Improving environment and cleaning • Enhancing information to staff and patients • Spotting outbreaks more readily • Discharge planning • Environmental surveillance and typing

  14. The Target • Is it useful • Missed targets cause bad publicity • Meeting target becomes main aim not improving patient care

  15. Any questions?

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