Combating Clostridium difficile at Home

 

One Hospital's Success and How It Can Help Caregivers

When a 410-bed hospital in Atlanta, Georgia, faced a high rate of hospital-acquired C difficile infections (HO CDI), it decided to tackle the problem head on. Emory Saint Joseph’s Hospital leadership assembled a diverse team of professionals to develop strategies to combat HO CDI in its facility.

Clostridium difficile is a bacteria spread by the oral-fecal route. Antibiotic use raises the risk, particularly in vulnerable and older patients. It strikes approximately half a million people each year. Though usually considered an infection acquired in hospital settings, the team discovered that many patients already had C diff upon admission, underscoring its risk in the community setting.

After investigating the causes of the hospital’s cases between 2014-2016, the team developed the following infection prevention interventions:

*Better diagnostic stewardship. Nurses were allowed to test any loose, unformed stools within the first three days of admission.

*Enhanced environmental cleaning. A more effective sporicidal disinfectant was incorporated in the daily cleaning routine for ALL rooms, not just isolation rooms.

*More judicious use of antimicrobials for infection. Medications called fluoroquinolones were removed from standalone orders and only given when approved through certain channels. Medicines in this category raise the risk of contracting Clostridium difficile.

*Education of staff. The team incorporated training with enhanced communication to bring the best practices for infection control to the forefront.

*Accountability. Staff meetings were held to increase compliance with the new measures.

One year after incorporating these changes, infection rates had dropped 63%. After three years, infection rates had dropped 77%.

The team found the single most effective infection control intervention was handwashing. Simple, thorough washing with water and soap. Alcohol hand gels are not effective.

How can this help patients and their caregivers at home?

Besides the obvious benefit of clinical infection control for its inpatients, caregivers can learn from and incorporate some of this hospital's interventions at home.

This study clearly showed that C diff is a community problem, as well as an institutional one. As obvious as it might seem, the most important things we can do for our loved ones are often the simple ones.

*Wash our hands often and well. Use soap and warm water. Rinse thoroughly. Keep a roll of paper towels at each sink and use them instead of one household towel to dry. Sure, this costs money, but it’s a small price to stop the spread of disease.

*Keep the home clean. This boosts both our emotional and physical well-being. Not all cleaning products kill C diff but can help with general infection control. If you have C diff infection, do your research to find a home-approved product that kills their spores.

*Discuss the administration of fluoroquinolones with the medical provider and resist their over-prescription if C diff has been a problem. Have a respectful conversation and get the necessary answers to your questions. 

You, as a caregiver, are the most important member of the healthcare team caring for your loved one. You are the first-line of defense against infection. Your efforts to give your loved one quality care are not just necessary. They’re vital. Never feel you are “just” the caregiver. Your concerns, questions, and observations are critical to providing the best care possible for your family.

This article is for general information only and not meant to take the place of regular medical care or a physician's advice.

Study information gleaned from an original article in the American Journal of Infection Control, as presented on Medscape.org.

Thai Government Reports Possible Treatment for 2019-nCoV Coronavirus

A recent report out of Thailand claims that an anti-viral cocktail administered to a Thai patient infected with the 2019-nCoV coronavirus has resulted in a dramatic improvement in symptoms.

JewishPress.com reports that Dr. Kriengsak Attipornwanich of Thailand’s Health Ministry announced the news on Sunday, February 2, 2020. According to him, the patient initially tested positive for the new coronavirus. The anti-influenza drug oseltamivir, along with and lopinavir and ritonavir, was administered to the patient. Lopinavir and ritonavir are both anti-viral drugs used to treat HIV.

Forty-eight hours later, lab tests on the patient for the coronavirus were negative, and the patient appeared much improved.

Research is continuing to replicate these results and confirm the drugs’ effectiveness in other patients.

This report comes as worldwide infection has now surpassed 20,000 cases in at least twenty-five nations. Experts are predicting this strain of coronavirus will become pandemic, or global. The U.S. administration has declared a public health emergency. Eleven people are now confirmed with the disease in the U.S., with no deaths to date. The World Health Organization has declared a global emergency, and the Centers for Disease Control has issued an advisory against nonessential travel to China.

Although frightening because of its high contagion, the 2019-nCoV coronavirus is still much less deadly than this year’s influenza. It’s important to keep from panicking, use common sense in general caregiving tasks, and practice standard infection control to lessen the chances of acquiring either disease.

Sources:

https://www.jewishpress.com/news/breaking-news/thai-doctors-successfully-treat-coronavirus-with-antiviral-drug-cocktail/2020/02/02/

https://www.foxnews.com/health/experts-worry-about-pandemic-coronavirus-numbers-increase

What You Need to Know about the Coronavirus (2019-nCoV)

A new (novel) virus, called the coronavirus (2019-nCoV), has alarmed the public and health care providers alike in recent weeks. It emerged from Wuhan, Hubei Province, China, and has rapidly spread to Australia, Canada, France, Japan, Macau, Malaysia, Nepal, Taiwan, Thailand, South Korea, Singapore, Vietnam, and the United States. The first cases were reported on December 31, 2019, according to LiveScience.com. 

Early indications are that the virus may have come from the Huanan seafood market. It was initially thought to be connected to human infection from animals sold at the market who carried the coronavirus. But continued infection in people with no connection to the market has pointed to human-to-human infection. At this point, it is unknown how the virus is being spread. It appears to be spreading during the incubation period, before a person begins to develop symptoms, making it especially dangerous.

Symptoms are believed to appear from 2-14 days after exposure. Common symptoms are fever, cough, and fatigue. Some less common symptoms are coughing up blood or sputum that may be blood-tinged, headache, and diarrhea. Complications have included acute respiratory distress syndrome, anemia, acute cardiac injury, and secondary infection. 

Treatment for now consists of supporting the patient's systems while the body fights the disease. No antiviral treatment has been effective against 2019-nCoV. Corticosteroids have been administered in some cases, but it is unknown whether these treatments were beneficial. Trials are now being conducted to find effective treatments and a vaccine against the disease.

Currently, the Centers for Disease Control and Prevention (CDC) is recommending that those who either have the disease or are being tested for it wear a mask. This may prevent the transmission of disease through larger fluid droplets. But according to Fox News, Dr. William Schaffner, a professor of preventive medicine and infectious diseases at Vanderbilt University, and the medical director of the National Foundation for Infectious Diseases, has warned that wearing surgical face masks won't prevent the spread of the disease.

A respirator may be more effective if worn correctly. But for now, conscientious hand-washing is recommended. The CDC has listed the following ways to minimize exposure to this virus:

• Wash your hands often with soap and water for at least 20 seconds. If soap and water are not available, use an alcohol-based hand sanitizer.
• Avoid touching your eyes, nose, and mouth with unwashed hands.
• Avoid close contact with people who are sick.
• Stay home when you are sick.
• Cover your cough or sneeze with a tissue, then throw the tissue in the trash.
• Clean and disinfect frequently touched objects and surfaces.

Sources: 

https://www.livescience.com/new-china-coronavirus-faq.html

https://www.contagionlive.com/

https://www.foxnews.com/health/do-surgical-masks-protect-against-coronavirus

https://www.cdc.gov/coronavirus/index.html

https://www.cdc.gov/coronavirus/2019-ncov/about/prevention-treatment.html

Is Your Phone Making Someone Sick?

At a busy doctor's office recently, I got in line to check my son in for a routine visit. Instead of the old-school clipboard they used to update patient information, the receptionist handed me an electronic tablet. I took it reluctantly, scrolled through the prompts with the stylus, and confirmed the information on the display. I stood back in line and handed it in.

Then I went to the bathroom and thoroughly washed my hands.

Am I paranoid about getting sick? Yes, I am. As a caregiver to a son with high medical needs, I can't afford to be sick for even one day. Although we have grown children who help us a lot, I am the only one who does all the skilled nursing treatments required by my son's high-level spinal cord injury. And because we operate a certified nursing home to care for our son, regulations define who can come in to assist us.

Our son's fragile respiratory status, his father's commitment to watch him every night while he is on the ventilator to sleep, and our youngest daughter's struggle to juggle caregiving with a full-time job, makes the health of our household a vital concern.

A cold for others is an inconvenience. For us, it is a disaster.

According to a recent issue of RN Idaho, a magazine published by the American Nurses Association of Idaho for Idaho's nurses, my concerns about mobile devices are well-founded. In the article, "Mobile Bugs: Are Pathogens on Your Devices?" the authors assert that mobile devices are, indeed, potential reservoirs for pathogens.

Every year more than 90,000 people die in the United States from healthcare acquired infections, also known as HAIs. HAIs are infections acquired during a stay in a hospital. Researchers have found that up to 95% of phones in hospitals were colonized with bacteria, of which 5% were pathogenic. Some pretty nasty bugs were found on them, including MRSA, E. coli, Acinetobacter, Enterobacter, Klebsiella, and Pseudomonas. Viruses like rotavirus and adenovirus were also discovered.

The most disturbing news was that most healthcare providers reported that they didn't regularly clean their mobile devices. Although a direct connection between contaminated mobile devices and HAI's has not been established, it should be treated as a real possibility.

And even though research has concentrated on HAIs in a hospital setting, common sense would suggest that community settings - and especially ones in which sick people are concentrated - should be treated as potential infection pools, as well.

Prevention from infection can be as simple as regularly cleaning our own mobile devices at home and those we use on the job. It should, of course, become a habit to wash our hands before feeding or otherwise giving care to those in our charge. And we should speak up when we see a healthcare provider forget to wash up before providing care to us or a loved one.

Breaking the cycle of infection is an important way to keep ourselves and those we love healthy.





Callegos, Cara; Hong-Engelhard, Cindy; McDuffee, Veronica; Boeck, Caitlyn (2017, August, September, October). Mobile Bugs: Are Pathogens on Your Devices? RN Idaho, 5.